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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400448
Report Date: 12/27/2023
Date Signed: 12/27/2023 01:40:16 PM


Document Has Been Signed on 12/27/2023 01:40 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:NAZARETH HOUSEFACILITY NUMBER:
100400448
ADMINISTRATOR:O'NEILL, ROSEMARY, R.N.FACILITY TYPE:
740
ADDRESS:2121 NORTH FIRST STREETTELEPHONE:
(559) 237-2257
CITY:FRESNOSTATE: CAZIP CODE:
93703
CAPACITY:110CENSUS: 72DATE:
12/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH: Administrator Rosemary O’NeillTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Kamaldeep Kaur arrived unannounced to conduct a case management visit regarding a Decision and Order notice from the Caregiver Background Check Bureau (CBCB) requiring removal of Staff #1.

LPA met with Administrator Rosemary O’Neill and informed the reason for visit. LPA spoke with Administrator who confirmed S1 was not on premises. Administrator confirmed S1 was terminated on 10/19/2019 and disassociated on that date. The facility did not have a termination letter or any evidence in proof since records have been destroyed.

Exit interview conducted. Report signed on site by Administrator and a copy of this report was provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2023
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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