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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404229
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:18:07 PM

Document Has Been Signed on 07/21/2023 03:18 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:STEPHANIE'S HOUSE A HOME FOR SPECIAL PEOPLEFACILITY NUMBER:
100404229
ADMINISTRATOR:SNYDER, ELSA V.FACILITY TYPE:
735
ADDRESS:42825 WEST VALERIATELEPHONE:
(209) 392-3778
CITY:DOS PALOSSTATE: CAZIP CODE:
93620
CAPACITY: 13CENSUS: 13DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Administrator- Elsa SnyderTIME COMPLETED:
03:30 PM
NARRATIVE
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On 7/21/23 at 10:46 a.m. Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct an annual inspection. LPA was greeting by caregiver Lorena S. and allowed entrance into the facility. Administrator Elsa Snyder was contacted and informed of the reason for the visit. Administrator arrived at the facility at a later time. Tour of the facility was conducted with caregiver Lorena S.

LPA toured the facility inside and out. LPA observed fire extinguishers to be last serviced 12/13/22 and in good standing condition. LPA checked water temperature in kitchen, water temperature read at 114.4 degrees Fahrenheit. LPA observed staff testing smoke and carbon monoxide detectors which are in working condition.

LPA observed entry and exits points to be clear and free from obstructions. LPA observed facility to be free from clutter. Facility currently has 13 residents. LPA observed each resident has their own room with proper furniture, storage, and lighting.

LPA observed a sample of resident and staff files. Administrator has current Administrator Certificate on file.

Administrator stated due to poor reception the facility does not have internet access for residents, this deficiency is citable. LPA reviewed files and facility did not have an infection control plan on file, this deficiency is citable.

Exit interview was conducted and a copy of this report & LIC809D was provided to administrator.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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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Document Has Been Signed on 07/21/2023 03:18 PM - It Cannot Be Edited


Created By: Brianna Miranda On 07/21/2023 at 02:27 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: STEPHANIE'S HOUSE A HOME FOR SPECIAL PEOPLE
FACILITY NUMBER: 100404229

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85095.5(a)
Infection Control Requirements
(a) A licensee shall ensure that infection control practices are maintained as follows: 

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Administrator will create a plan and keep on file. Plan will be sent to LPA.
Type B
Section Cited
HSC
1537.1(a)
Regulations
(a) A licensee of a residential facility serving adults that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for client use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Administrator will look into internet and device options. Administrator will provide information to LPA
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:Brianna Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023


LIC809 (FAS) - (06/04)
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