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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406030
Report Date: 01/17/2023
Date Signed: 01/17/2023 02:47:01 PM

Document Has Been Signed on 01/17/2023 02:47 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:UNITED CEREBRAL PALSY OF CENTRAL CA, INC-ADULT PRFACILITY NUMBER:
100406030
ADMINISTRATOR:CUNNINGHAM, KELLYFACILITY TYPE:
775
ADDRESS:4224 N. CEDAR AVE.TELEPHONE:
(559) 221-8272
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 120CENSUS: 92DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Administrator, Kelly CunninghamTIME COMPLETED:
02:45 PM
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On 01/17/2023, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct an Annual
Inspection- Infection Control. LPA introduced self; met with Administrator Kelly Cunningham and discussed the purpose of the visit.

Visitor log-in/temperature check, masks, and disinfection station observed upon entry. Facility has one
entrance/exit point. Staff observed with facial coverings. Hand sanitizer was readily available to clients and
visitors. Fire extinguishers were serviced on 04/12/2022. Hand washing and other various Covid-19 related
signs were observed in the common areas.

All passageways and exits were clear and free from obstruction. Facility was at a comfortable temperature and well lit. All classrooms and activity areas were clean and odor free. Bathrooms were clean and fixtures were functioning properly.

Facility kitchen area toured and appeared clean. Clients bring their own lunches to program. LPA observed
knifes and cleaning supplies locked in the kitchen pantry. LPA observed the following personal protective
equipment in office, hand sanitizer, gloves, and masks. Staff records were reviewed for infection control
training. Client files have updated with emergency contact information.

No deficiencies were observed.

An exit interview was conducted. The following documents are requested and need to be submitted to Fresno
CCL by 1/24/2023. Designation of Facility Responsibility LIC308, Administrator Organization LIC309,
Personnel Report LIC500, Emergency and Disaster Plan LIC610D, and Register of Facility Clients LIC9020.

Report signed on-site by Administrator and a printed copy was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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