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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209140
Report Date: 09/24/2021
Date Signed: 09/24/2021 10:00:03 AM

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: 4DATE:
09/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Staff Lucila JiminezTIME COMPLETED:
09:55 AM
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Licensing Program Analyst (LPA) Darius Williamd conducted a visit to drop off requested PPE. LPA Williams met with staff Lucila Jimenez and discussed the purpose of the visit.

LPA Williams provided the following; 3 packs of gloves, 3 sanitizers, 3 packs of masks, and 1 pack of face shields.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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