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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208772
Report Date: 01/14/2025
Date Signed: 01/14/2025 03:40:48 PM

Document Has Been Signed on 01/14/2025 03:40 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ROSE MEADOW MANORFACILITY NUMBER:
107208772
ADMINISTRATOR/
DIRECTOR:
LEIJA, RITAFACILITY TYPE:
740
ADDRESS:5627 N BOND STREETTELEPHONE:
(559) 840-1991
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Rita LeijaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 01/14/2025 at 11:00 AM, Licensing Program Analyst (LPA) Daiquiri Boyd arrived unannounced to conduct an Annual inspection. LPA was allowed entry by caregiver staff, Vanessa Castellanos. Licensee Rita Leija was phoned and came to the facility a short time later.

LPA tour the inside and outside of the facility. The facility was observed to be at a comfortable temperature of 73 degrees F, clean, in good repair, and no passageway obstructions. Cleaning supplies and chemicals are stored and locked under the kitchen sink and in the garage. Sharps are locked and stored in the kitchen area. Medications are kept locked in the hallway closet. All bedrooms were observed to have required furnishings and with adequate lightening. LPA observed three bedrooms. Bathroom is properly equipped, and the hot water temperature was tested at 116.7 degrees F. Carbon monoxide and smoke are dual detectors, they were tested and observed to be operational. A sample of staff and client’s files were reviewed. First Aid checked and fully stocked. Fire extinguisher was serviced on December 6, 2023.

The following updated forms are to be submitted to CCL by 01/31/25 : LIC 500, LIC 610D

An exit interview was conducted. A copy of this report was left with Administrator, Rita Leija whose signature on this form confirms receipt of these documents.

Sergiy PidgirnyTELEPHONE: (559) 243-8080
Daiquiri BoydTELEPHONE: 559-243-8080
DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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