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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208887
Report Date: 12/07/2021
Date Signed: 12/07/2021 03:04:47 PM

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:FIVE STAR ASSISTED LIVING CORPFACILITY NUMBER:
107208887
ADMINISTRATOR:OGANYAN, HASMIK JASMINEFACILITY TYPE:
740
ADDRESS:2573 W. BARSTOW AVETELEPHONE:
(559) 283-8543
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 4DATE:
12/07/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jasmine Oganyan - LicenseeTIME COMPLETED:
03:30 PM
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An Informal Office Meeting was held on 12/07/2021 at the Fresno Regional Office. The purpose of the office meeting was to provide discuss concerns expressed by the license.

The informal conference process was explained during this meeting.

The following were in attendance:

Jasmine Oganyan- Licensee/Administrator

See Moua- Licensing Program Manager
David Ayers- Licensing Program Analyst

During this meeting the following topics were discussed:

Prohibited Health Conditions
Acceptance and Retention Limitations
Process for requesting exceptions
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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