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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406684
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:11:59 PM


Document Has Been Signed on 03/19/2024 04:11 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:SIERRA VIEW HOMES RESIDENTIAL CAREFACILITY NUMBER:
100406684
ADMINISTRATOR:PENNER, VIRGINIA B.FACILITY TYPE:
741
ADDRESS:1155 E. SPRINGFIELDTELEPHONE:
(559) 638-9226
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY:78CENSUS: 49DATE:
03/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator, Virginia PennerTIME COMPLETED:
04:01 PM
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On 3/19/2024 Licensing Program Analyst (LPA) M. Garza arrived for an unannounced case management visit. LPA met with Administrator, Virginia Penner explained reason for visit and was permitted entry into the facility. A health and safety check was completed on residents in care. LPA observed residents in common areas and in rooms.

This case management is being completed for 2 special incidents received by the facility.

Special incident #1 was received on R1. R1 had received some unexplained bruising. LPA reviewed medical chart which notated R1 had a fall. R1 was seen by the physician the following day and assessed with no additional orders. LPA reviewed records and completed interviews. At this time, no further follow up needed.

Special incident #2 was received on R2 stating that R2 had a fall resulting in R2 being taken to the ER. R2 has a history of falls. It was reported R2 sustained a suspected GI bleed. Hospital noted a GI lesion that explained reason for concern. LPA reviewed records and completed interviews. At this time, no further follow up needed.

No deficiencies cited during todays visit. Exit interview completed with Administrator, Virginia Penner. A copy of this report given.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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