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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206929
Report Date: 07/12/2024
Date Signed: 07/12/2024 11:14:52 AM


Document Has Been Signed on 07/12/2024 11:14 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:PAINTBRUSH ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
107206929
ADMINISTRATOR:JENNIFER VASQUEZFACILITY TYPE:
740
ADDRESS:4356 W ASHLAN AVETELEPHONE:
(559) 275-2000
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:110CENSUS: 65DATE:
07/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Melinda OcaranzaTIME COMPLETED:
11:30 AM
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On 7/12/2024 Licensing Program Analyst (LPA) Katie Brown arrived unannounced for a case management - other inspection regarding immediate exclusion of Staff 1 (S1). LPA was greeted by Facility Designee, Resident Care Director (RCD) Melinda Ocaranza. LPA introduced self, stated the purpose of the visit. LPA requested to meet with Administrator Jennifer Vasquez who was out of the facility and unable to attend the visit.

LPA discussed Staff (S1) with RCD. LPA informed Administrator that S1 is excluded and cannot work or be on the premises of the facility and should be disassociated. During the visit, LPA confirmed that S1 never worked at the facility and was disassociated 7/3/2024.

No deficiency was observed.

An exit interview was conducted and a copy of this report was provided to RCD, whose signature confirms receipt of this report via email - mocaranza@paintbrushassistedliving.com
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
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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