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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201156
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:46:15 PM


Document Has Been Signed on 09/10/2024 03:46 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: 260DATE:
09/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Administrator Desiree ValeroTIME COMPLETED:
04:00 PM
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On 9/10/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a case management visit. LPA met with Administrator Desiree Valero.

LPA reviewed R1 and R2's charts.

R1 was a resident at the facility from 5/30/24 and passed on 7/17/2024. R1 did not have any major medical issues listed on physician report. R1 did not have previous complaints regarding medical concerns. R1 was found by housekeeping in their apartment. Administrator was not informed of cause of death.

R2 was a resident at the facility since 4/1/2024 and was sent to the hospital on 5/2/2024. R2's physician report listed diagnoses of kidney disease and passed at the hospital from septic shock.

Neither resident had prior incidents recorded at the facility before their passing. LPA spoke with staff who did not have additional information to provide.

No deficiencies were noted at this time and no citations were issued.

Exit interview was conducted an a copy of this report 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: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024
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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