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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209429
Report Date: 01/08/2025
Date Signed: 01/13/2025 11:19:40 AM

Document Has Been Signed on 01/13/2025 11:19 AM - 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 ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:REALOVE MANORFACILITY NUMBER:
247209429
ADMINISTRATOR/
DIRECTOR:		AGRAVANTE, CHERRY ANNEFACILITY TYPE:
734
ADDRESS:6071 JOSIE CTTELEPHONE:
(310) 347-6614
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 5CENSUS: 0DATE:
01/08/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee, Cherry AgravanteTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. LPA arrived and was granted entry to the facility by Licensee Cherry Anne Agravante. An initial application to operate a Adult Residential for People with Special Health Care Needs (ARFPSHN) was submitted to the Central Applications Unit (CAU) on 01/09/2024 for a capacity of five adult residents.

LPA Hurt observed the following:

Structure:
Facility is a one-story house with 5 resident bedrooms, 2 bathrooms, family / living room, dining area and kitchen. There is a 3-car garage attached in front of home. The resident bedrooms will accommodate residents' furnishings.
Signal System:
Central air/heating system installed with a central panel to control entire house.
Bedrooms Residents:
Bedrooms #1-5 will accommodate 5 clients (each client will have private bedroom)
Bathrooms:
All bathrooms have a working toilet, wash basin, and shower.
Linens and Hygiene Supplies:
Adequate supply of linens is stored in hallway cabinet.
Emergency Phone Numbers, Exit Plan, and Sample Menu:
Will be posted and readily available for review in facility.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: REALOVE MANOR
FACILITY NUMBER: 247209429
VISIT DATE: 01/08/2025
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Continued from 809C...

Food Service:


Adequate supply of 7-day non-perishable and 2 day perishables would be stored in the kitchen and pantry.
Smoke and Carbon Monoxide Detectors:
Smoke and carbon monoxide alert systems were hardwired and found operational.
Fire Extinguisher:
2 Fully charged and located inside nurses station area, and one located in kitchen area.
Fire Clearance:
Approved on 12/11/2024
Appliances:
Electric four burner stove with oven, refrigerator/freezer and microwave which were clean and noted to be operational. Washer and dryer are located in the laundry area in the laundry room close to entrance to garage, and were clean and noted to be operational.
Toxins:
Will be locked away/ stored in locked cabinets in bathroom, and above washer and dryer.
Water Temperature:
Tested and recorded at 110 degrees (within regulation)
Medications, First Aid Kit & Manual:
First Aid kit with guide will be stored in nurses station area. Medication will be stored and locked in closet near nurses station area. Licensee explained the facility will soon acquire a medication cart.
Resident and Staff Files:
Records for residents will be in locked area in nurses station (open area to left of home when you enter front door.) Staff files will be kept in locked file cabinet in facility office area.
Reading Material, Games, Equipment, & Materials:
The facility has materials that commensurate with their plan of operation.

Continued onto 809C..
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: REALOVE MANOR
FACILITY NUMBER: 247209429
VISIT DATE: 01/08/2025
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 Continued from 809C ..

The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Unit.

Applicant was reminded of the statute that requires notification to Licensing Program Analyst within 5 business days of admitting the first resident. This notification may be done by phone, mail, email or fax.

At this time, facility has met all pre - licensing requirements of Title 22 division 6.

An exit interview was conducted with Licensee Cherry Anne Agravante and a copy of this report was provided at the time of visit.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
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