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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206798
Report Date: 09/27/2022
Date Signed: 09/27/2022 12:11:27 PM


Document Has Been Signed on 09/27/2022 12:11 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:ASPEN RESIDENTIAL CARE HOMES INC IIFACILITY NUMBER:
107206798
ADMINISTRATOR:YARBROUGH, SHELLYFACILITY TYPE:
740
ADDRESS:3107 W GETTYSBURG AVETELEPHONE:
(559) 492-2026
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 6DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Karen EscobedoTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Inspection - Infection Control. LPA met with and explained the reason for the visit with facility designee Karen Escobedo.

LPA toured the facility inside and out. Upon entry, LPA observed a posted visitor policy, visitor log/symptom screening, sanitizer and PPE. Covid-19 symptom and precautionary signs are posted throughout the facility. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPA observed soap and paper towels at all sinks, required food supply, paper products, 30-day PPE and resident medications. Cleaning/disinfecting products were locked. LPA reviewed quarantine/isolation procedures and staff vaccination requirements with AD. LPA observed the facility pool with required locked gate. LPA reviewed resident emergency contact information. Fire and Carbon Monoxide alarms were observed. Fire Extinguishers dated 11/15/2022. Administrator Certificate expiration 10/12/23.


No deficiencies cited during this inspection.


An exit interview was conducted. A copy of this report was left with Karen Escobedo whose signature confirms receipt of these documents.

LPA requested the following updated forms by 10/7/22: LIC 308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610E, LIC 9020 and a copy of current Liability Coverage.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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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