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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208801
Report Date: 11/25/2024
Date Signed: 11/25/2024 04:04:30 PM

Document Has Been Signed on 11/25/2024 04:04 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:FRESNO GUEST HOME #11FACILITY NUMBER:
107208801
ADMINISTRATOR/
DIRECTOR:
ANGELICA KUTNERIAN GLESSFACILITY TYPE:
740
ADDRESS:2562 E MAGILL AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
11/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:56 PM
MET WITH:Teresa LongTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 11/25/2024, Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by staff and explain the purpose of the visit. Administrator Teresa Long (AD2) arrived at the facility to assist in the inspection.

The residence was set at 76 F temperature and free of passageway obstructions inside and outside. LPA observed six bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 116.1 degrees F.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the kitchen area. Cleaning supplies were locked in the laundry room. Smoke detectors and carbon monoxide are dual detectors, they were checked and operating. Fire extinguishers were charged and was serviced on 08/05/24. Emergency disaster drills are conducted quarterly, last drill completed on 09/01/2024. First Aid kit was observed and found to be fully stocked.

LPA reviewed 3 staff files and 3 client binders.

There was outdoor seating for the residents. Outdoor area was clean and free of obstruction.

An exit interview was conducted, and a copy of this report was provided to AD2 whose signature confirms receipt.


No deficiencies were cited on this day.
LPA requested the following updated forms faxed to CCLD by 12/06/24 Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage.
Sergiy PidgirnyTELEPHONE: (559) 243-8080
Daiquiri BoydTELEPHONE: 559-243-8080
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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