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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206561
Report Date: 10/13/2023
Date Signed: 10/13/2023 12:22:47 PM


Document Has Been Signed on 10/13/2023 12:22 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:SUNNY GARDENFACILITY NUMBER:
107206561
ADMINISTRATOR:SANTOS, CARLOFACILITY TYPE:
740
ADDRESS:3033 E. LOS ALTOS AVETELEPHONE:
(559) 439-5760
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 4DATE:
10/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Maricris MagpiliTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by staff and explain the purpose of the visit. Facility Manager, Maricris Magpili arrived at the facility minutes after.


The residence was set at 70 F temperature and free of passageway obstructions inside and outside. LPAs observed four bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 105.3 degrees F.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medications are locked in a cabinet next to the shared living area. Knives are locked in the kitchen area. Cleaning supplies are locked under the kitchen sink. Smoke detectors and carbon monoxide were checked and operating. Fire extinguishers were charged and was serviced on 3/29/2023. Emergency disaster drills are conducted quarterly, last drill completed on 4/11/2023.

There was outdoor seating for the residents. Outdoor area was clean and free of obstruction.

An exit interview was conducted, and a copy of this report was provided to Facility Manager whose signature confirms receipt.



LPA requested the following updated forms faxed to CCLD by 10/20/23: Designation of Facility Responsibility (LIC308), Plan of Operation, Administrative Organization (LIC309), Personnel Report (LIC 500), LIC613, Proof of current Liability Coverage, Administrator's certificates and Administrator’s CPR/First Aid.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam FloresTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
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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