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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208240
Report Date: 03/27/2024
Date Signed: 03/27/2024 07:32:58 PM

Document Has Been Signed on 03/27/2024 07:32 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:LYNN HOMEFACILITY NUMBER:
107208240
ADMINISTRATOR:TATUM, ATLENAFACILITY TYPE:
735
ADDRESS:2715 HELM AVETELEPHONE:
(559) 348-9946
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 6CENSUS: 5DATE:
03/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Administrator Atlena Tatum and Administrator Donna TaylorTIME COMPLETED:
08:00 PM
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Licensing Program Analyst Shawna Doucette (LPA) arrived at the facility unannounced to conduct a Required Annual inspection. LPA was grand entry by Staff Anthony Delgado. Staff contacted Administrator Atlena Tatum and Administrator Donna Taylor who responded to the facility to assist with the visit.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Facility was set at 73 F. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 110 degrees F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching and goes out to an alley.

Fire extinguisher serviced on 5/11/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire and earthquake drill conducted 3/1/2024. All cleaning supplies are locked and secured in a closet upstairs. Medications were locked in a closet.

Medications were reviewed. Staff files and Resident files were reviewed.

An exit interview was conducted with the Administrator and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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