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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208240
Report Date: 03/05/2025
Date Signed: 03/05/2025 11:12:25 AM

Document Has Been Signed on 03/05/2025 11:12 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:LYNN HOMEFACILITY NUMBER:
107208240
ADMINISTRATOR/
DIRECTOR:
TATUM, ATLENAFACILITY TYPE:
735
ADDRESS:2715 HELM AVETELEPHONE:
(559) 348-9946
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 6CENSUS: 5DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Donna TaylorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Daiquiri Boyd arrived unannounced to conduct the Annual inspection. LPA observed clients being picked up and taken to day program. LPA was granted entry by Caregiver Marshae Jones and explain the purpose of the visit. Phone call was made to Administrators Donna Taylor and Atlena Tatum, who arrived shortly after.

During this visit, LPA toured the facility inside & out. Facility is a two story home, no bedrooms were in the upstairs. Resident rooms are on the main floor and contained required furnishings and lighting. Resident hygiene supplies were properly stored and available in the upstairs storage room. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPA observed required food supply and paper products. Medications are centrally stored and locked in a closet off of the living room. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. First aid kit was checked and contained all required items, First Aid kit is fully equipped. Laundry room was observed and washer and dryer were new and clean and in a central hall.

Smoke detectors and carbon monoxide were checked and operating. Fire extinguisher was charged and was serviced on 05/01/2024. Emergency disaster drills are conducted monthly, last drill completed on 03/02/2025.

No deficiencies cited on this day.


LPA requested the following updated forms faxed to CCLD by 03/19/2025: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coverage.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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