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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209544
Report Date: 12/27/2024
Date Signed: 01/06/2025 02:08:21 PM

Document Has Been Signed on 01/06/2025 02:08 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 ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BL&C RESIDENTIALFACILITY NUMBER:
247209544
ADMINISTRATOR/
DIRECTOR:		COWARD, BRANDYFACILITY TYPE:
735
ADDRESS:804 E. CLINTON AVETELEPHONE:
(209) 812-4678
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 6CENSUS: 5DATE:
12/27/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee, Brandy CowardTIME 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 Brandy Coward. An initial application to operate a Adult Residential Facility (ARF) was submitted to the Central Applications Unit (CAU) on 10/09/2024 for a capacity of six adult residents.

LPA Hurt observed the following:
Structure:
Facility is a one-story house with 3 resident bedrooms, 1 staff bedroom, 2 bathrooms, 1 family / living room, dining area and kitchen. The facilities washer and dryer is located near the garage.
Signal System:
The facility has central air/heat setup.
Bedrooms Residents:
Bedrooms #1-3 will accommodate 6 clients
The bedrooms have required furnishings including bed with linens, dresser, night stands, and lamp.
Bathrooms:
The facility has two bathrooms with working toilets, and sinks.
Linens and Hygiene Supplies:
Adequate supply of linens are located throughout the facility.
Emergency Phone Numbers, Exit Plan, and Sample Menu:
The facility has required Personal rights, and State Licensing PUB 475 postings at this time.

Continued..
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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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: BL&C RESIDENTIAL
FACILITY NUMBER: 247209544
VISIT DATE: 12/27/2024
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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 area.
Smoke and Carbon Monoxide Detectors:
Smoke and carbon monoxide alert systems were hardwired and found operational.
Fire Extinguisher:
2 Fully charged and stored by front entrance near kitchen, and one in the hallway.
Fire Clearance:
Approved on 11/21/2024.
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 room in the hallways and were clean and noted to be operational.
Toxins:
Cleaning supplies are on sight in washroom and in garage in locked cabinets.
Water Temperature:
Facility hot water temperature is measured at 110 degrees.
Medications, First Aid Kit & Manual:
The facility has first aid kit located in the front closet area.
Resident and Staff Files:
Records will be kept in filing area in locked cabinet in living area area.
Reading Material, Games, Equipment, & Materials:
The facility has cable television, and a few magazines, art supplies, and music.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC809 (FAS) - (06/04)
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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: BL&C RESIDENTIAL
FACILITY NUMBER: 247209544
VISIT DATE: 12/27/2024
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Continued onto 809C..

LPA Hurt reviewed ARF Component III with Licensee Brandy Coward.

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


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

An exit interview was conducted with Licensee's Brandy Coward, 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: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC809 (FAS) - (06/04)
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