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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404809
Report Date: 02/11/2025
Date Signed: 02/11/2025 04:50:03 PM

Document Has Been Signed on 02/11/2025 04:50 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:PALM VILLAGE RETIREMENT COMMUNITYFACILITY NUMBER:
100404809
ADMINISTRATOR/
DIRECTOR:
JIM HIGBEEFACILITY TYPE:
741
ADDRESS:703 WEST HERBERT AVENUETELEPHONE:
(559) 638-6933
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 262TOTAL ENROLLED CHILDREN: 0CENSUS: 70DATE:
02/11/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:37 AM
MET WITH:Administrator, Karly AlcantarTIME VISIT/
INSPECTION COMPLETED:
10:58 AM
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On 2/11/25 Licensing Program Analyst (LPA) M. Garza completed an unannounced case management visit. This case managment visit is being conducted to clear deficiencies previously cited during an annual visit made on 1/30/25. LPA met with Administrator, Karly Alcantar and explained reason for visit. LPA completed a health and safety check on residents in care.

The following issues were cited during visit conducted on 1/30/25: Facility sketch did not include meeting location for Disaster Preparedness. Snack area was observed with cabinet full of debris in need of cleaning and a hole needing repair under sink. Beverage servers/ice dispenser in snack area and kitchen galley observed dirty, in need of cleaning. Tools/items posing a danger observed outside off kitchen unlocked and accessible. Kitchen doorway observed with broken tile/laminate in need of repair/replacement.

Facility sketch was updated to include meeting locations. A copy was provided to CCL. Snack area was observed with cabinet cleaned and hole repaired. Beverage servers/ice dispenser in snack area and kitchen galley observed to be clean. Training was completed. A copy of the in-service sign in sheet and training material was provided to CCL. Tools/items posing a danger were picked up and disposed of making inaccessible. Kitchen tile/laminate was repaired.

The following issues were provide TV's during visit conducted on 1/30/25: Food in freezer inside snack area not properly stored. Food in kitchen refrigerator observed not properly stored and in need of disposal. White sputum observed in hallway in need of cleaning/disinfecting. Trash cans off kitchen observed overflowing and in need of disposal. These items were corrected during visit conducted on 1/30/25.

Deficiencies cleared. Exit interview completed with Administrator, Karly. A copy of this report and proof of correction letters provided.
See MouaTELEPHONE: (559) -580-4596
Mary GarzaTELEPHONE: 559-365-9009
DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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