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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204161
Report Date: 10/20/2023
Date Signed: 10/20/2023 12:24:58 PM


Document Has Been Signed on 10/20/2023 12:24 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:GREEN GABLES CARE HOME VII, INC.FACILITY NUMBER:
107204161
ADMINISTRATOR:SHEAKALEE, MARSHAFACILITY TYPE:
740
ADDRESS:1422 ASH AVENUETELEPHONE:
(559) 298-7302
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 5DATE:
10/20/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lorik SheakaleeTIME COMPLETED:
12:30 PM
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On 10/20/23, Licensing Program Analyst (LPA’s) M. Flores and M. Garza made an unannounced case management visit. LPAs were granted entry to the facility by care staff, Joseph and Gamaree Whigan. Licensee, Lorik Sheakalee, was contacted by and stated she was unable to come to the facility. LPA was informed that Assistant, Mario Ramos arrived at the facility minutes later. LPAs completed a tour of the facility inside and out and health and safety check on residents in care. Residents observed in common areas and in rooms.

During the facility tour the following was observed by LPAs:

1. Lock installed on top of the entrance door.

2. Cleaning supplies unlocked in the bathroom.

3. Chemicals unlocked in the laundry room.

4. Door alarm to the sliding door turned off.

5. Side walkway was accessible to residents and observed to be unleveled and missing paver rocks.

Technical Violations provided for the above issues. Exit interview completed with Assistant, Mario Ramos. A copy of this report provided to Mario Ramos.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam FloresTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023
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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