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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208260
Report Date: 11/25/2024
Date Signed: 12/03/2024 10:43:09 AM

Document Has Been Signed on 12/03/2024 10:43 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:J H CARE FACILITYFACILITY NUMBER:
107208260
ADMINISTRATOR/
DIRECTOR:		MILLER, JACOBFACILITY TYPE:
735
ADDRESS:2464 S MARIONTELEPHONE:
(559) 304-7318
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 2CENSUS: 2DATE:
11/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Jacob Miller, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 11/25/2024, Licensing Program Analyst (LPA) Rachel Bruce arrived unannounced at the facility for the purpose of conducting an annual inspection. LPA was met by Administrator (AD) Jacob Miller. LPA explained the purpose of the visit and AD had no questions.

LPA toured both the interior and exterior of the home. The home has 5 bedrooms, 2 bathrooms, laundry room, garage being utilized for storage, stocked secondary refrigerator and freezer. Locked chemicals are stored in hall closet off kitchen. Client Medication is secured and stored in office. There is adequate living space and currently there are 2 residents, all ambulatory. LPA observed the bedrooms to be clean and orderly and all had appropriate furnishings meeting regulatory requirements. No bedrooms are shared. One client was present during the inspection while the other was visiting family for the holiday. Both residents are clients of CVRC.

In the resident bathrooms LPA tested water temperature which was found to be within regulations measuring 105 degrees Celsius.

Tour of the outside revealed no issues. Grounds are clean, self latching gate is functioning and there are no obstructions throughout the facility including outdoors. The pool has appropriate security gate. There were places to recreate and no obstructions present.

The kitchen was toured and observed to be in good repair with necessary items and appliances. Dishware and utensils sufficient for 2 residents observed. Sharps and knives were properly stored and were locked and inaccessible. LPA observed food supply and found that there was sufficient perishable items meeting the 2 day requirement and 7 days of non-perishable food available.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: J H CARE FACILITY
FACILITY NUMBER: 107208260
VISIT DATE: 11/25/2024
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Medication records were reviewed and found to be accurate and updated. Pill count was conducted and no errors found. Medications are centrally stored and locked in a cabinet located in the office.

First aid kit located in office and found to contain required items. Fire extinguisher located in the kitchen serviced/ purchased March 2024. Smoke and carbon monoxide detectors tested and found to be operational.

LPA conducted review of resident files. LPA found the files contained required documentation. Accounting for P&I funds was appropriately documented. AD to ensure that records are maintained and routinely updated. Medical documentation appropriately filed and up to date. Required documentation was present including physician assessment and current Needs and Services plan.
LPA conducted review of staff files. All were complete and appropriate documentation present.

No citations were issued at this visit.

The following documents or information are to be mailed or faxed to licensing by December 15, 2024.
1.) Current Facility Staff Roster / Work Schedule form LIC500
2.) Current Register of Facility Clients/Residents form LIC9020
3.) Copy of current Administrator Certificate


Exit interview conducted and copy of report provided to AD.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
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