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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700703
Report Date: 01/12/2024
Date Signed: 01/23/2024 04:28:01 PM

Document Has Been Signed on 01/23/2024 04:28 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: DATE:
01/12/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Meeting NotesTIME COMPLETED:
12:00 PM
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On this date, 01/12/2024, Licensing Program Analyst (LPA) Renee Campbell and Licensing Program Manager (LPM) Lisa Rios, met with Jessica Villasenor, Program Team Lead (PTL) and Vartan Hekimian, Facility Administrator (FA) on Microsoft Teams at the licensee’s request for the purpose of establishing an open line of communication in order to work collaboratively with the CCLD.

The FA started the meeting by describing to LPA Campbell and LPM Rios the type of facilities he runs and the clients he serves. The residents at this facility would otherwise be or have been incarcerated. They all exhibit some type of undesirable behaviors and the FA wanted to make it understood during the meeting that the 1:1.7 ratio and resident and staff Safety Plan was of upmost priority. The Facility Administrator stated that at this time he provides a 1:1.7 ratio. However, his contractual ratio with the regional center is 1:2.5.”

LPA Campbell and LPM Rios understood and explained that while undesired behaviors couldn’t be prevented that as long as staff was aware of incidents, documented incidents, reported incidents, and Safety Plans were followed then inquiries and investigations would take all into consideration.

A copy of this report has been emailed to the FA for signature.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
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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