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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208887
Report Date: 01/27/2022
Date Signed: 02/01/2022 04:06:48 PM

Document Has Been Signed on 02/01/2022 04:06 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
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: 6DATE:
01/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jasmine Oganyan - Licensee/Administrator TIME COMPLETED:
02:45 PM
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LPA contacted Licensee/Administrator Jasmine Oganyan to conduct a Required Annual Inspection. LPA conducted the inspection via tele-visit due to COVID-19 precautionary measures. LPA announced the purpose of the visit.

LPA and Licensee/Administrator reviewed infection control protocols and best practices. LPA toured the facility and observed facility infection control measures. LPA observed the facility to have sufficient personal protective equipment, cleaning supplies, and food stuffs. LPA observed required postings and screening procedures. No deficiencies were cited during the inspection. A copy of the report was provided to the Licensee/Administrator via email.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2022
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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