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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203409
Report Date: 08/23/2024
Date Signed: 08/23/2024 10:58:47 AM

Document Has Been Signed on 08/23/2024 10:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BAGHETTI-HOMEFACILITY NUMBER:
107203409
ADMINISTRATOR/
DIRECTOR:
BAGHETTI-ESCALANLE,ROXANNAFACILITY TYPE:
735
ADDRESS:2737 NORWICH AVENUETELEPHONE:
(559) 346-1232
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 4DATE:
08/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator-Roxanna BaghettiTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 08/23/24 Licensing Program Analysts (LPA) J. Leffall and L. Xiong arrived unannounced to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit, and was greeted by Administrator (A1) Roxanna Baghetti. LPAs were granted entry. 3 clients were present during inspection and then departed for Day Program.

LPAs toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 37 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 1/11/24. Fire drill last completed on 08/22/24. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested 111.1 degrees F. in all 3 bathrooms. Outside of facility toured. Side gates were self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cart. Clients’ MARS was reviewed. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have all the required documents. A sample of staff files and all clients’ files were reviewed and observed to have all the required documents.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 08/31/24: Lic 308, Lic 500, Lic 610D, and Lic 9020. LPA received a copy of current Administrator certificate. A copy of this report was provided to Administrator whose signature on this form confirms receipt of this report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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