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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209415
Report Date: 05/02/2024
Date Signed: 05/02/2024 04:33:02 PM

Document Has Been Signed on 05/02/2024 04:33 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:FULMER HOMESFACILITY NUMBER:
107209415
ADMINISTRATOR/
DIRECTOR:		FULMER, CANDISFACILITY TYPE:
735
ADDRESS:4442 E ASHCROFT AVETELEPHONE:
(559) 792-5562
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 3CENSUS: 0DATE:
05/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee/Administrator (L/A) Candis FulmerTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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A scheduled Prelicensing visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Licensee/Administrator (L/A) Candis Fulmer.

Facility phone number is (559) 978-9665. Program reviewed. Facility applying for 3 ambulatory on clients through Regional Center. No pools, spa, hot tub, fountains, or other bodies of water on the premises. Facility has wood burning fireplace not in use or to be used.

Physical plant toured. Dining & sufficiently furnished with adequate lighting. Kitchen has storage area for knives. Seven (7) day perishable food on the premises. Appliances clean @ appropriate temperatures. Client bedrooms toured. Observed to be sufficiently furnished with adequate lighting. Client bathroom toured. Fixtures operational. Fire extinguisher service date: 11/30/23. Smoke detectors/carbon monoxide detectors tested & observed to be operational. Outside & garage area toured. Outside sufficiently furnished. No hazards observed. Interior & exterior passageways observed to be clear with no obstructions.

Component III conducted.

Exit interview conducted with L/A. Report provided.

"Pre-Licensing is incomplete with deficiencies to be resolved by 5/6/24. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies."
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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