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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209007
Report Date: 01/21/2025
Date Signed: 01/22/2025 07:56:06 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/22/2025 07:56 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:FIVE STAR ASSISTED LIVINGFACILITY NUMBER:
107209007
ADMINISTRATOR/
DIRECTOR:		OGANYAN, HASMIK JASMINEFACILITY TYPE:
740
ADDRESS:5727 N. HAZEL AVETELEPHONE:
(818) 261-4887
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/21/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Hasmik Jasmine OganyanTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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On 1/21/25, Licensing Program Analysts (LPAs) M. Medina and M. Garza conducted an unannounced annual required inspection. LPAs stated the purpose of the visit and were allowed entry into the facility. Administrator contacted by direct care staff and arrived a short time later to meet with LPAs. LPAs conducted facility tour with direct care staff.

LPA Medina reviewed a sample of staff and resident files and observed the files to have the required documentation and staff training.

LPA Garza will document the physical plant tour and inspection tool results on a separate report.

Exit interview conducted and facility report signed by Administrator. No deficiencies cited on this report. Due to technical problems. A copy of this report will be emailed to Administrator.
Melinda HoffmannTELEPHONE: (559) 341-3247
Melinda MedinaTELEPHONE: (559) 410-5914
DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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