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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209140
Report Date: 07/21/2021
Date Signed: 07/21/2021 02:10:38 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:GAREM ASSISTED LIVINGFACILITY NUMBER:
107209140
ADMINISTRATOR:HOPPER, JOCELYN BAREFACILITY TYPE:
740
ADDRESS:4266 N 9TH STREETTELEPHONE:
(559) 940-9708
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: 2DATE:
07/21/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jocelyn HopperTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) L. Xiong conducted a case management visit for the purpose of Health and Safety check of residents in care. I met with Administrator, Jocelyn Hopper and informed her the purpose of the visit.

Currently, 2 residents living in the facility and 1 receiving home health services.

A tour of the facility was conducted. Facility observed to be clean and odor free. Facility temperature comfortable. LPA measured water temperature 109 degrees F. Adequate food supply to meet the needs of residents. Fire Extinguisher current. Carbon monoxide detectors and smoke detectors observed operational during today's visit. LPA observed medication cabinet in hallway to be locked and inaccessible to residents during inspection.

LPA observed residents in their rooms.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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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