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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204205
Report Date: 01/26/2024
Date Signed: 01/26/2024 03:20:58 PM

Document Has Been Signed on 01/26/2024 03:20 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:EDGEMONT HOMEFACILITY NUMBER:
157204205
ADMINISTRATOR:MCCRAW, CHERYLFACILITY TYPE:
735
ADDRESS:5501 EDGEMONT DRIVETELEPHONE:
(661) 833-8805
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 3DATE:
01/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cheryl McCrawTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by caregiver staff and explained the purpose of the visit. Administrator, Cheryl McCraw arrived a few minutes later. No resident were present during this visit.

The residence was set at 67 degrees F temperature and free of passageway obstructions inside and outside. LPA observed three bedrooms in the residence. Three of the rooms were found to be clean and furnished.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked next to the kitchen. PPE is stored in their medication closet Smoke detectors and carbon monoxide were checked and operating. Fire extinguisher was last serviced on 5/12/2023. There is outdoor seating.

An exit interview was conducted, and a copy of this report was provided to Administrator, Cheryl McCraw whose signatures confirms receipt.

During the visit, a file review was conducted for clients and staff files.

LPA requested the following updated forms faxed to CCLD by 02/09/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Emergency Disaster Plan (LIC610E), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
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)
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