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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700703
Report Date: 11/23/2021
Date Signed: 11/23/2021 01:39:53 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/23/2021 01:39 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:PAULSON COMMUNITY- YOSEMITE HOME, THEFACILITY NUMBER:
502700703
ADMINISTRATOR:HEKIMIAN, ARENFACILITY TYPE:
735
ADDRESS:2804 PAULSON RDTELEPHONE:
(559) 228-3056
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 5CENSUS: 5DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Vartan Hekimian. TIME COMPLETED:
01:45 PM
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Licensing program Analyst (LPA) Jason Lund conducted an unannounced annual required visit at the above Facility. LPA met with the CEO, Vartan Hekimian. LPA toured the facility inside and outside.

The facility has 1 common area, Staff office, a staff bathroom and 5 resident rooms with a bathroom in each. There is a meeting area, dining area, computer area, Health and Wellness area and a laundry area. There are client bathrooms with grab bars, paper towels and soap. There are cameras on the outside of the building.

The Facility has a kitchen area with a sink, refrigerator and dishwasher. The medications will be locked in the Staff office. There is a delayed egress on the front door, side gate from the backyard and exterior gate in the common area of the facility.

There are designated cabinets for client’s belongings outside of each room. Locked file cabinets are located in the staff office for files. The Administrator will put in place, the disaster plan, client rights and facility sketch on the wall. Fire extinguishers and smoke detectors are current and in compliance with fire safety.

Exit interview held with the Administrator and a copy of report given at the conclusion of the visit.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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