<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201878
Report Date: 01/07/2025
Date Signed: 02/18/2025 10:30:46 AM

Document Has Been Signed on 02/18/2025 10:30 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:GLENDORA GUEST HOMEFACILITY NUMBER:
275201878
ADMINISTRATOR/
DIRECTOR:		HONESTO R. FERNANDEZFACILITY TYPE:
735
ADDRESS:1905 GLENDORA WAYTELEPHONE:
(831) 443-8746
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 6CENSUS: 6DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Licensee, Honesto Fernandez. TIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee, Honesto Fernandez, Continual Administrator's Certification expires 03/30/2025. There are currently 6 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 105 degrees. Toxins and cleaning supplies are locked and inaccessible.

LPA Hurt observed the facility temperature below 64 degrees. LPA Hurt observed the hallway bathroom door is in disrepair and does not lock. LPA observed the facility resident bedroom trashes with no lids. LPA observed the facility bathroom has shared hand towels. LPA observed the facilities fire extinguisher has not been serviced within the last 12 months. The facility does not have an Infection Control Plan. The facilities first aid kit is not complete. LPA observed window screen on left side of facility ripped and in disrepair. LPA observed front resident bedroom dresser drawers to be in disrepair.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Licensee, Honesto Fernandez and copy of report left at facility
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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 2
Document Has Been Signed on 02/18/2025 10:30 AM - It Cannot Be Edited


Created By: Sarah Hurt On 01/07/2025 at 05:40 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: GLENDORA GUEST HOME
FACILITY NUMBER: 275201878

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
80087 Buildings and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in LPA observed hallway bathroom door to be in disrepair and does not lock, front bedroom resident drawer broken in disrepair, facility vents need cleaning, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2025
Plan of Correction
1
2
3
4
Licensee will send proof of fixed hallway bathroom door, and resident bedroom dresser to LPA by 01/21/2024 POC date.
Type B
Section Cited
CCR
85095.95(c)
85095.5 Infection Control Requirements
(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 85022.

(1) The Infection Control Plan shall include all of the following:


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in the Licensee could not provide required Infection Control Plan, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2025
Plan of Correction
1
2
3
4
Licensee will submit required Infection Control Plan to LPA by POC date of 01/21/2025.
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: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2