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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275200250
Report Date: 02/11/2025
Date Signed: 02/12/2025 01:52:21 PM

Document Has Been Signed on 02/12/2025 01:52 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: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:
02/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Licensee, Honesto FernandezTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sarah Hurt arrived unannounced to conduct a Case Management visit on 02/11/2025. LPA met with facility Licensee, Honesto Fernandez, Aida Fernandez, and stated the purpose of the visit.


LPA Hurt observed facility bedroom 1 does not have required furnishings (lamp.)

LPA Hurt observed facility temperature to be below 68 degrees.


Exit interview conducted with facility Licensee Honesto Fernandez, and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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Document Has Been Signed on 02/12/2025 01:52 PM - It Cannot Be Edited


Created By: Sarah Hurt On 02/11/2025 at 01:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: FERNANDEZ GUEST HOUSE
FACILITY NUMBER: 275200250

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2025
Section Cited
CCR
8088(a)(1)

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80088 Furniture, Fixtures, Equipment, and Supplies(a) A comfortable temperature for clients shall be maintained at all areas.(1) The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C). The following requirement has not been met as evidenced by:
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Licensee agrees to ensure the facility temperature to be at least 68 degrees, and send proof to LPA by POC date of 02/25/25.
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LPA observed the facility temperature to be cold, below 68 degrees, which poses a potential, health, safety, or personal rights risk ti residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


LIC809 (FAS) - (06/04)
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