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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209246
Report Date: 11/30/2022
Date Signed: 12/05/2022 11:20:36 AM


Document Has Been Signed on 12/05/2022 11:20 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814



FACILITY NAME:LAURITE SENIOR CARE HOMEFACILITY NUMBER:
107209246
ADMINISTRATOR:IDUSUYI, INNOCENTFACILITY TYPE:
740
ADDRESS:5478 E LAURITE AVETELEPHONE:
(559) 297-6771
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: 4DATE:
11/30/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Innocent IdusuyiTIME COMPLETED:
12:01 PM
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Facility Type: RCFE
Application Type: CHOW
Capacity: 6
Census (if any clients in care): 4
COMP II Participants: Innocent Idusuyi CEO/Administrator

Interview Method: Telephone interview with CAB

During COMP II, Applicant/Administrator confirmed the understanding of the California Code Title 22 Regulations.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of
following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Procedures
3. Staffing requirements & Training
4. Program policies -restricted/prohibited health conditions; food service management;
emergency procedures; medication management; activities program
5. Complaints & Reporting
6. Application document review and technical assistance- Criminal record clearance; Health screening; Fire clearance; First Aid/CPR certificate; Administrator certificate; Financial verification; Compliance history; Control of property
SUPERVISOR'S NAME: Tracy ThompsonTELEPHONE: (916) 657-2025
LICENSING EVALUATOR NAME: Ricmar SorianoTELEPHONE: (916) 617-7083
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
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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