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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275200250
Report Date: 03/06/2025
Date Signed: 05/20/2025 09:55:48 AM

Document Has Been Signed on 05/20/2025 09:55 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:FERNANDEZ GUEST HOUSEFACILITY NUMBER:
275200250
ADMINISTRATOR/
DIRECTOR:		HONESTO R. FERNANDEZFACILITY TYPE:
735
ADDRESS:1007 POLK STREETTELEPHONE:
(831) 443-8746
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 6CENSUS: 3DATE:
03/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:00 PM
MET WITH:Licensee, Honesto FernandezTIME VISIT/
INSPECTION COMPLETED:
07:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management. LPA met with facility Licensee Honesto Fernandez, and explained the purpose of today's visit.

Staff 1 was holding Resident 1's ring and it was not listed on the LIC 621 Safeguard for Personal Property and Valuables.

Technical Assistance was reviewed, and exit interview conducted with facility Licensee Honesto Fernandez, and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Brenda Chan
NAME OF LICENSING PROGRAM ANALYST: Sarah Hurt
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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