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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206609
Report Date: 06/23/2022
Date Signed: 06/23/2022 11:01:59 AM


Document Has Been Signed on 06/23/2022 11:01 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
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: DATE:
06/23/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Licensee Elizabeth DyerTIME COMPLETED:
09:30 AM
NARRATIVE
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On June 23, 2022 an informal office meeting was conducted with Licensee Elizabeth Dyer.
Present during the meeting are:

Licensee/ Licensee Representatives
Licensing Program Manager Sergiy Pidgirny
Licensing Program Manager See Moua
Licensing Program Analyst Shawna Doucette
Licensing Program Analyst Vadim Gorban

The following issues/ concerns associated with the operation of the facility were brought forward and discussed with the Licensee/ Licensee Representative(s):

87755 Inspection Authority of the Licensing Agency
87205 Accountability of Licensee Governing Body
1569.312 Basic services requirements
87405 Administrator - Qualifications and Duties
87411 Personnel Requirements – General (…In facilities licensed for sixteen or more)
87555 General Food Service Requirements (…In facilities licensed for sixteen (16) to forty-nine (49))
87303 Maintenance and Operation
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: GETTYSBURG CHRISTIAN HOME
FACILITY NUMBER: 107206609
VISIT DATE: 06/23/2022
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Licensee advised the other Licensee Karen Davis on the license moved out of state and is no longer Licensee. Licensee Elizabeth Dyer advised Licensee Karen Davis bought her out however she never submitted LIC 200 to make the change.

License provided LIC500 indicating 3 staff plus an Administrator.

Licensee confirmed that there is only one staff on duty per shift at the moment.

Licensee advised she is going to put the facility up for sale. LPM Sergiy Pidgirny explained the process to Licensee on how to close the facility.

An exit interview was conducted with Licensee Elizabeth Dyer.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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