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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206671
Report Date: 02/19/2025
Date Signed: 02/19/2025 01:38:22 PM

Document Has Been Signed on 02/19/2025 01:38 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:CLARK FAMILY RES.INC. DBA CLARK HOUSEFACILITY NUMBER:
107206671
ADMINISTRATOR/
DIRECTOR:		CLARK, JAMESFACILITY TYPE:
735
ADDRESS:2545 N. SELLAND AVETELEPHONE:
(559) 981-2524
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Jahnaya ClarkTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Daiquiri Boyd arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Jahnaya Clark and Dyana Hannemann.

During this visit, LPA toured the facility inside & out. Resident bedrooms are found in good repair, contained required furnishings and lighting. The resident bathroom was clean and in good repair. LPA observed required hygiene items and grab bars. Towels, extra bedding, and linens were stored and available for use. Resident bathroom hot water measured 105 degrees. The kitchen was clean, in good repair with necessary items and appliances. LPA observed required food supply, PPE and paper products. Knives/sharps, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored in a locked closet. A First aid kit contained required items. There are visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. LPA observed a self-releasing gate and windows have screens in good repair. Smoke and Carbon Monoxide detectors are present and were tested during the visit. The Fire extinguishers were serviced by Valley Fire 6/05/2024. LPA conducted resident and staff file reviews including medication check. The Emergency Disaster Plan and Infection Control Plans were reviewed.

Emergency supplies are kept in the garage.

There were no citations during this inspection. An exit interview was conducted and a copy of this report was provided to AD, whose signature confirms receipt.



LPA requested the following updated forms faxed to CCLD by 2/28/2025: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Emergency Disaster Plan (LIC610D), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402) Personnel Report (LIC 500). Client Roster (LIC 9020), Proof of current Liability Coverage and the updated Infection Control Plan.
Sergiy PidgirnyTELEPHONE: (559) 243-8080
Daiquiri BoydTELEPHONE: 559-243-8080
DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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