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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404229
Report Date: 07/12/2024
Date Signed: 07/28/2024 11:15:46 PM

Document Has Been Signed on 07/28/2024 11:15 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/
DIRECTOR:		SNYDER, ELSA V.FACILITY TYPE:
735
ADDRESS:42825 WEST VALERIATELEPHONE:
(209) 392-3778
CITY:DOS PALOSSTATE: CAZIP CODE:
93620
CAPACITY: 13CENSUS: 13DATE:
07/12/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 7/12/24 Licensing Program Analyst B. Miranda arrived at the facility unannounced to complete the annual inspection that was originally started on 7/8/24. LPA introduced herself, stated purpose of visit, and was allowed entrance by staff. Administrator Elsa Snyder was contacted and arrived at a later time.

LPA observed the facility to be clean, clutter free, odor free, and all emergency exits to be obstruction free.

LPA observed a sample of resident files and a sample of staff files once Administrator arrived. Files are current and up to date.
Administrator was informed to have files readily accessible when LPA is at the facility.

LPA reviewed the centrally stored medication log for the residents and did not find any deficiencies.

No citation were issued at today's visit.

Exit interview was conducted and a copy of this report was provided to Administrator.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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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