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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209432
Report Date: 05/06/2024
Date Signed: 05/06/2024 05:47:16 PM

Document Has Been Signed on 05/06/2024 05:47 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:GEARHART HOMEFACILITY NUMBER:
107209432
ADMINISTRATOR/
DIRECTOR:		GALLEGOS, AARONFACILITY TYPE:
735
ADDRESS:4908 N GEARHART AVETELEPHONE:
(559) 473-5619
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 4CENSUS: 0DATE:
05/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Applicant Licensee Manager-Member/Administrator (L/A) Aaron Gallegos & House Manager (HM) Amanda GutierrezTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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A PreLicensing visit was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA met with Applicant Licensee Manager-Member/Administrator (L/A) Aaron Gallegos & House Manager (HM) Amanda Gutierrez.

Facility telephone # (559) 319-8840. Facility has wood burning fireplace that is not in nor will be in operation. Facility has no pools, spa, hot tub, fountains &/or other bodies of water. Capacity for 4 (four) clients. Fire Cleared for Ambulatory only.

Physical plant tour began in dining, living room. Rooms sufficiently furnished with adequate lighting. Kitchen toured. Working appliances that appeared to be clean. 7-day supply non-perishable observed on the premises. Resident bedrooms sufficiently furnished with adequate lighting. Resident bathrooms toured. Working fixtures. Appeared & smelled clean. Hot water measured @ 117 degrees F.

Garage & outside area toured. No hazards observed. Exterior & interior passageways observed to be clear of obstructions. Smoke detectors tested & observed to be operational. Working carbon monoxide detector present. Fire extinguisher service date: 1/22/24.

Component III conducted @ time of visit.

"Pre-Licensing is complete and this facility has no deficiencies."

Exit interview conducted with L/A & HM. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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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