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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107200699
Report Date: 03/14/2025
Date Signed: 03/16/2025 07:38:42 PM

Document Has Been Signed on 03/16/2025 07:38 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:LOOP #2FACILITY NUMBER:
107200699
ADMINISTRATOR/
DIRECTOR:		LOOP, STEVENFACILITY TYPE:
735
ADDRESS:1342 SAN JOSETELEPHONE:
(559) 437-9657
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 4DATE:
03/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator, Joseph RafananTIME VISIT/
INSPECTION COMPLETED:
03:01 PM
NARRATIVE
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On 3/14/25 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA contacted Licensee, Steven Loop. stated it was okay to complete visit with Administrator, Joseph Rafanan and Designee, Alicia Rafanan. LPA introduced self, explained reason for visit and was permitted entry into the facility. Licensee, Steven arrived some time later.

LPA toured the facility inside and out. Residents were attending day program during visit. Pathways and doorways were clear and free from obstruction. Facility observed to be clean and without odor. Common areas were clean and adequately furnished. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 9/11/24. Last fire drill on 1/10/2025. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. Medications observed in a locked cabinet off kitchen. LPA observed sufficient seating under covered patio areas.

The following issues were observed during todays visit: Bathroom #2 shower tiles broken in need of repair or replacement. Caulking around shower in bathroom #1 in need of replacement. Toilet seat in bathroom #1 in need of cleaning or replacement. Light in bathroom #1 missing cover and in need of drywall repair. Reclining chair in living room observed torn and in need of repair or disposal. Side walkway observed with moss in need of cleaning. Wall in garage (at dryer vent cover) in need repair. Wall in dining area in need of drywall repair. Facility does not have a facility device to access the internet. Facility has plan in place but not have all required items. Deficiencies and TV's provided per Title 22.

CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LOOP #2
FACILITY NUMBER: 107200699
VISIT DATE: 03/14/2025
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CONT...

LPA requested the following documents to be submitted to CCL by 3/21/25 : current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Exit interview completed with Administrator, Alicia Rafanan. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/16/2025 07:38 PM - It Cannot Be Edited


Created By: Mary Garza On 03/14/2025 at 02:10 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: LOOP #2
FACILITY NUMBER: 107200699

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in bathroom #2 shower tiles broken in need of repair or replacement. Caulking around shower in bathroom #1 in need of replacement. Toilet seat in bathroom #1 in need of cleaning or replacement. Light in bathroom #1 missing cover and in need of repair. Reclining chair in living room observed torn and in need of repair or disposal. Side walkway observed with moss in need of cleaning. Wall in garage at dryer vent cover in need repair. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/28/2025
Plan of Correction
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Administrator stated they will make corrections and send pictures by POC date as proof of correction.
Type B
Section Cited
HSC
1565
1565 Disaster Preparedness
(a) A facility shall have an emergency and disaster plan that shall include, but not be limited to, all of the following:


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation the facility has disaster plan in place but is missing items. Facility sketch does not have meeting location identified. 1 location listed is not outside the immediate area. Plan to keep medications not listed. This poses a potential health, safety and or personal rights risk to persons in care.

POC Due Date: 03/21/2025
Plan of Correction
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Administrator stated they will submit an updated Disaster Prepardness Plan to CCL with annual documents by POC date as proof of correction.
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:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2025


LIC809 (FAS) - (06/04)
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