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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206609
Report Date: 01/30/2023
Date Signed: 01/30/2023 06:29:30 PM


Document Has Been Signed on 01/30/2023 06:29 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:GETTYSBURG CHRISTIAN HOMEFACILITY NUMBER:
107206609
ADMINISTRATOR:DYER, ELIZABETHFACILITY TYPE:
740
ADDRESS:4844 E. GETTYSBURGTELEPHONE:
(559) 294-9080
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:18CENSUS: 13DATE:
01/30/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
05:20 PM
MET WITH:Elizabeth DyerTIME COMPLETED:
06:45 PM
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Licensing Program Analyst (LPA) and Licensing Program Manager (LPM) Sergiy Pidgirny arrived unannounced at the facility unannounced to conduct a Case Management- Health Checks visit. LPA and LPM explained the purpose of the visit to Administrator (AD) Elizabeth Dyer.

Upon arrival, LPA and LPM observed AD serving dinner to residents in the dining room. LPA Brown confirmed that AD was the only staff member working at the facility at the time.

During the visit, LPA and LPM toured the facility, interviewed AD and reviewed staff files.


AD has agreed to submit a current Personnel Record (LIC 500) to LPA by 5PM 1/31/2023.






No deficiencies were cited during this visit.

An exit interview was conducted. A copy of this report was left with Elizabeth Dyer whose signature confirms receipt of these documents.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2023
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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