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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209140
Report Date: 04/24/2022
Date Signed: 04/24/2022 04:39:54 PM


Document Has Been Signed on 04/24/2022 04:39 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: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: 5DATE:
04/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Staff Rose MorrellTIME COMPLETED:
02:30 PM
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Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA was met by Staff Rose Morrell and discussed the purpose of the visit. LPA contacted Administrator via telephone who gave permission for Staff Rose Morrell to sign for this report. LPA and Staff began the tour at the front entrance/office of the facility. Administrator will submit LIC808 within a week of this report.

Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies were observed behind a locked cabinet in garage. LPA observed the following personal protective equipment in a storage cabinet in laundry room; gowns, face shield, gloves, and masks. Staff records were reviewed for infection control training. Resident’s files have updated emergency contact information.

During tour of facility LPA observed a staff bedroom in the garage. Facility sketch does not show room on fire clearance. Administrator stated the room was recently fire cleared and she will submit documentation by the end of the week. At this time there is no citation however LPA may return at a later date pending submission of documentation and further file review.

No deficiencies were observed.

Exit interview was conducted and a copy of this report was provided
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2022
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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