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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203409
Report Date: 10/31/2024
Date Signed: 10/31/2024 04:26:39 PM

Document Has Been Signed on 10/31/2024 04:26 PM - 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: DATE:
10/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Administrator-Roxanna EscalanteTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 10/31/24 at 2:30pm Licensing Program Analyst J. Leffall conducted an unannounced visit for a Case Management regarding an incident reported on 10/20/24. Staff (S1) Connie Julian greeted LPA and LPA stated purpose of the visit. No residents were present upon arrival but shortly after, residents were arriving from day program. LPA reviewed records and interviewed staff and residents that had knowledge of incident reported on 10/20/24. Administrator (A1) Roxana Escalante arrived shortly after.

No citations were warranted based on information and records given.


A written report was given to A1 which confirms receipt of report and signature.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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