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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201156
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:01:20 PM


Document Has Been Signed on 08/04/2023 12:01 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:FAIRWINDS - WOODWARD PARKFACILITY NUMBER:
107201156
ADMINISTRATOR:VALERO, DESIREEFACILITY TYPE:
740
ADDRESS:9525 N FT WASHINGTON RDTELEPHONE:
(559) 434-6444
CITY:FRESNOSTATE: CAZIP CODE:
93730
CAPACITY:270CENSUS: 229DATE:
08/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Administrator- Desiree ValeroTIME COMPLETED:
12:15 PM
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On 8/4/2023 at 10:40 a.m. Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct a case management for a death report previously submitted to the department. LPA entered the facility and was greeted by staff. LPA met with Administrator Desiree Valero and explained the reason for the visit.


Administrator went over the events that took place when R1 fell on 6/14/23. S1 was one of the staff members who assisted R1 when they fell. LPA interviewed S1.

On 6/14/23 R1 fell in the hall way of the facility and S1 assisted with the call. S1 called for backup and 2 staff members assisted R1 to their feet with a walker. S1 walked with R1 to their apartment. S1 tended to R1's wound on the arm. S1 also called and informed family members of the incident. Thirty minutes after S1 left R1's apartment paramedics arrived to the facility to take R1 to the hospital.

LPA did not find any deficiencies and no citations were issued at this time.


Exit interview was conducted and a copy of this report (LIC809) was provided to Administrator Desiree Valero.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
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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