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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404229
Report Date: 11/02/2022
Date Signed: 11/03/2022 02:21:12 PM

Document Has Been Signed on 11/03/2022 02:21 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:
11/02/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Elsa SnyderTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPA’s) Sarah Hurt and Brianna Miranda arrived at the facility on 11/02/22 to conduct a Case Management visit. LPA’s met with Administrator Elsa Snyder and explained the purpose of today's visit. Elsa arrived to the facility without a mask and did not wear one during the visit.

LPA’s toured the facility including kitchen, resident bedroom, and outdoor areas. LPA’s observed a large double wide trailer on the facility grounds. The Administrator stated the double wide trailer is currently being rented out to tenants, a husband, wife, and their three kids. Administrator Elsa Snyder stated they have been renting out the double wide for years and find tenants through word of mouth. Administrator Elsa stated the current tenant is sister to one of the facility caregivers. Administrator Elsa Snyder stated the tenants currently living there are not background cleared and have been living in the trailer since approximately September 1, 2022.


The following deficiencies were cited per Title 22 Regulations. Exit interview conducted with Administrator Elsa Snyder and a copy of this report was left at the facility along with appeals rights provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/03/2022 02:21 PM - It Cannot Be Edited


Created By: Brianna Miranda On 11/02/2022 at 12:21 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: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2022
Section Cited
CCR
80019(a)

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80019 Criminal Record Clearance
(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code Section 1522(b) and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. The following requirement has not been met as evidenced by:
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Administrator will send proof of background clearance for tenants living in double wide trailer on facility grounds to LPA by 11/03/2022.
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Based on LPA interviews with Administrator and observation the facility is renting a large double wide trailer to tenants who are not background cleared which poses an immediate risk to the health, safety, or personal rights of residents in care.
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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: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022


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