<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209471
Report Date: 01/09/2025
Date Signed: 01/09/2025 02:20:38 PM

Document Has Been Signed on 01/09/2025 02:20 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PAUL HOUSEFACILITY NUMBER:
107209471
ADMINISTRATOR/
DIRECTOR:		HER, LEEFACILITY TYPE:
735
ADDRESS:6537 N. SEVENTH AVE.TELEPHONE:
(559) 432-7052
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 6DATE:
01/09/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Lee HerTIME VISIT/
INSPECTION COMPLETED:
02:45 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 01/09/2025, Licensing Program Analyst (LPA) Daiquiri Boyd made a visit to the facility to complete a Pre-Licensing visit as well as a Comp III. LPA was greeted by Administrator Lee Her, and Sandra Douglas, LVN,Eri n Rosario RN.

LPA toured the facility and found that there are three rooms set up as client bedrooms with two beds in each room. All furnishings in these rooms are adequate and in working order. There is one room dedicated as dining and activity space. There is a living room area off of the kitchen.
There is one client bathroom, in good working order. Taps delivering hot water in the bathroom at 105F degrees.
There is ample living room space for visitors and residents to lounge and watch TV. Medications are stored in a locked cabinet in the kitchen area. Bedding and linens are ample for all residents and stored in the hallway closet.
There is perishable and non-perishable food for more than 7 days. There is adequate freezer space. There is a washer and dryer off the kitchen area.
There is a fire extinguisher in the kitchen that was serviced on 06/24/2024.
All smoke alarms and carbon monoxide detectors are operating properly.

There is Plan of Operation and Infection Control Plan.

Pre-Licensing is complete with no deficiencies.
Licensee's signature on this document confirms receipt.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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 1