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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107200055
Report Date: 09/15/2025
Date Signed: 09/15/2025 04:30:10 PM

Document Has Been Signed on 09/15/2025 04:30 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:WILLIAMS-WHITTLE RESIDENTIAL HOMEFACILITY NUMBER:
107200055
ADMINISTRATOR/
DIRECTOR:		WILLIAMS-WHITTLE, CHERYLFACILITY TYPE:
735
ADDRESS:821 W. VALENCIATELEPHONE:
(559) 441-8266
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY: 6CENSUS: 4DATE:
09/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:House Manager Laplac Christopher Maxie TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 09/15/25, Licensing Program Analyst (LPA) M.Yang arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff granted LPA entry to the facility and attempted to contact Administrator via telephone but were unsuccessful. LPA met with facility staff Raeisha Sykes and Robena James. House Manager Laplac Christopher Maxie was called and arrived shortly with all staff and clients’ files. LPA conducted toured of facility with House Manager.

During the inspection the facility appeared clean and odor free and at a comfortable temperature. Sharps and medications observed stored and locked in hall closet. Fire extinguisher is current with a service date of 01/09/25. Last fire drill conducted on 09/09/25. LPA reviewed medications and medications records. Upon review, LPA found that C1 medication was not accounted for. Medication Administration Record (MAR) and Centrally Stored Medication List was reviewed. Facility kitchen appeared to be clean and safe for food preparation. LPA observed an adequate food supply. Expired nonperishable food was observed. Cleaning chemicals observed locked in garage cabinet. Chemicals, gardening tools, and a tool were observed unlock in the garage.

All clients’ bedrooms were observed to have the required furnishings, adequate lighting, clean, and free of odor. Hot water temperature measured at 106.6 degree F in hall bathroom and 135.1 degree F in master bedroom bathroom. Extra linens and towels observed in hall closet. Exterior tour conducted, all exits open and free of obstructions.

CONTINUED TO 809C

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/15/2025 04:30 PM - It Cannot Be Edited


Created By: Mai Yang On 09/15/2025 at 03:56 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: WILLIAMS-WHITTLE RESIDENTIAL HOME
FACILITY NUMBER: 107200055

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(b)
80075 Health Related Services: (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on observations and records reviewed, the licensee did not ensure staff administering C1’s medication as prescribed by physician when LPA observed C1’s medication Clonazepam 1 mg bubble pack started on 08/29/25 with 13 left tablets left in the morning (AM) bubble pack and 15 tablets left in the evening (PM) bubble pack. MAR recorded medications was administered daily from 08/29/25 to 09/15/25. Medications was not accounted for, which poses an immediate health and safety risks to persons in care.
POC Due Date: 09/16/2025
Plan of Correction
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Licensee shall submit a written document of steps the facility will take to ensure facility meets the regulation which will include medication is administered as prescribed to Fresno CCL office by POC due date 09/16/25.

All staff will be retrained on medications. Licensee will submit documentation of training materials and staff attendance roster to the Fresno CCL office by 09/29/25.
Type A
Section Cited
CCR
80087(g)
80087(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily
available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:

Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, when LPA and Administrator observed at approximately 02:36PM, gardening tools and a automatic drill tool was observed against the garage wall next to the garage refrigerator unlock. Bleach bottles and two cleaning solutions were observed in the middle of the garage between a bike and some boxes unlock in the garage. Laundry detergent powers were observed on top of dryer unlock in the garage, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2025
Plan of Correction
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House Manager immediately removed tools from the facility and locked chemicals into lock cabinet in the garage. POC cleared during visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2025 04:30 PM - It Cannot Be Edited


Created By: Mai Yang On 09/15/2025 at 03:57 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: WILLIAMS-WHITTLE RESIDENTIAL HOME
FACILITY NUMBER: 107200055

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(1)
80088(e)(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot temperature of not less than 105 degrees (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on observation, hot water temperature in bathroom located in the master bedroom was measured at 135.1 degrees F, which poses/ posed a potential health and safety risk for the person in care.
POC Due Date: 09/22/2025
Plan of Correction
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The facility shall maintain hot water temperatures between 105 degree F and 120 degree F. The facility shall have a daily temperature log to ensure water temperature in master bathroom meets the regulation requirements. Daily temperature log with proof of hot water temperature is tested and maintained between 105 degree and 120 degree F shall be submitted to the Fresno CCL office by 09/22/25.
Type B
Section Cited
CCR
80066(e)
80066(e) All personnel records shall be maintained at the facility site and shall be available to the licensing agency for review

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above when S3's personnel file was not maintained at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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A written statement detailing the personnel records are kept in the facility shall be submitted to Fresno CCL by the POC due date 09/19/25. S3 record shall be maintained at the facility by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2025 04:30 PM - It Cannot Be Edited


Created By: Mai Yang On 09/15/2025 at 03:59 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: WILLIAMS-WHITTLE RESIDENTIAL HOME
FACILITY NUMBER: 107200055

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80068.3(a)
80068.3(a) The licensee shall ensure that each client's written Needs and Services Plan is updated as often as necessary to assure its accuracy, but at least annually. These modifications shall be maintained in the client's file.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above when 3 out of 4 clients did not have a current IPP on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2025
Plan of Correction
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Current IPP for three out of the four clients shall be obtained and submitted to the Fresno CCL office by POC due date 10/06/25.
Type B
Section Cited
CCR
80076(a)(1)
80076 (a)(1) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, multiple expired can foods were observed in the food pantry, which poses/posed an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2025
Plan of Correction
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House Manager immediately disposed expired food. POC cleared during visit.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: WILLIAMS-WHITTLE RESIDENTIAL HOME
FACILITY NUMBER: 107200055
VISIT DATE: 09/15/2025
NARRATIVE
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All clients’ file was reviewed. LPA found that 4 out of 4 clients do not have a current IPP on file. Personnel records were found to be complete and current. S3 personnel record was not available upon request for review. Smoke detectors and carbon monoxide detector observed to operational.

Deficiencies are being issued in accordance to California Code of Regulations, Title 22, Division 6 on the attached Lic 809D.

Technical Support Program (TSP) assistance was offered. Staff will inform Administrator/ Licensee and will make a decision and reach out the department regarding acceptance.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 09/22/25. Forms requested: Lic 308, Lic 400, Lic 402, Lic 500, Lic 610D, Lic 9020, and current Administrator certificate. A copy of this report and appeal rights was provided to the House Manager, whose signature on this form confirms receipt of this report.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
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