107209366-1-26-2024-24-AS-VGON-CZV3BV-20240126170656

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107209366
Report Date: 01/26/2024
Date Signed: 01/26/2024 05:07:26 PM

Document Has Been Signed on 01/26/2024 05:07 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	5 STAR RETIREMENT GROUP CORP		FACILITY NUMBER:	107209366
ADMINISTRATOR:	OGANYAN, HASMIK		FACILITY TYPE:	740
ADDRESS:	1577 E. QUINCY AVENUE		TELEPHONE:	(818) 261-4887
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	6	CENSUS: 0	DATE:	01/26/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:42 PM
MET WITH:	Administrator, Hasmik Ogasyan.		TIME COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/26/24 at 1400 hours, Licensing Program Analyst (LPA) V Gorban conducted an announced Pre-licensing visit. LPA met with Licensee, Hasmik Oganyan, certification number 6026996740, expiration date 06/23/25 and discussed the purpose of the visit. LPA began the tour at the entrance of the facility that has one entrance point. LPA toured the inside and outside of the facility. LPA observed no obstruction to emergency exit from back yard of the facility on east side of the property. The facility was observed at a comfortable temperature of 78 degrees Fahrenheit, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas furnished and well-lit throughout. LPA observed the kitchen to be absent of any trash or debris, sharp objects are secured and inaccessible to residents. At this time, seven-day supply of non-perishable food were observed. Medications and chemicals were kept locked in separate cabinets. Resident’s all four individual bedrooms were observed to be furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains. Bathrooms and showers were equipped with non-skid mats and securely fastened grab bars. The bathroom’s water temperature was tested at 111 degrees Fahrenheit. Towels, linens, and personal hygiene supplies were observed in storage. There are no bodies of water outside. Report continues on LIC 809-C

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: 5 STAR RETIREMENT GROUP CORP	FACILITY NUMBER: 107209366
	VISIT DATE: 01/26/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

All Fire extinguishers are current with service date of 10/10/2023. Carbon monoxide and smoke detectors were observed to be operational. First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, required phone numbers, and required postings were observed. A working facility telephone number (559-797-4202) was present and functional.

Component III was reviewed with Licensee and Administrator.

No deficiencies were observed during this visit. Report will be submitted Centralize Application Bureau for record and further processing of application.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2