<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201156
Report Date: 03/11/2024
Date Signed: 03/14/2024 10:24:57 AM


Document Has Been Signed on 03/14/2024 10:24 AM - 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: 251DATE:
03/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Administrator Desiree ValeroTIME COMPLETED:
05:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/11/24, Licensing Program Analyst (LPA) B. Miranda conducted a required unannounced Annual Inspection visit. LPA introduced herself, stated purpose of visit, and met with Administrator Desiree Valero.

LPA toured the facility inside and out to include entry, kitchen, dining area, common areas on all 3 floors, sample of bedrooms, bathrooms, and exterior. All fire exit routes were clear and free from obstructions. LPA observed facility to be clean, clutter free, and odor free. Medications are stored in med rooms which are inaccessible to residents. Toxins, cleaning supplies, knives and sharp objects are secured.

Facility has individual apartments for residents with individual bathrooms. Residents do not share bedrooms except couples. Facility has a capacity of 270 and currently has a census of 251. Fire extinguishers were last serviced 8/14/23 and are in good standing. Smoke detectors were last service 1/2024 Verification of carbon monoxide detectors will be provided to LPA by 3/25/24. Water temperature was checked in a common bathroom and read at 120 degree Fahrenheit.

LPA toured the kitchen at the facility. LPA observed some cabinets in the entry way of the kitchen needing to be cleaned, freezer holding ice cream needs to be cleaned if no longer using, and defrosting food items need to be properly covered. Citation was issued per the California Code of Regulations Tittle 22.
Sample of resident files were reviewed. Liability insurance policy is current. Sample of staff files were reviewed and some files did not reflect proper training to be current. Citation was issued per the California Code of Regulations Tittle 22.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Administrator.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
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 2


Document Has Been Signed on 03/14/2024 10:24 AM - It Cannot Be Edited

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: FAIRWINDS - WOODWARD PARK
FACILITY NUMBER: 107201156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above due to some staff members not having current training in certain areas, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2024
Plan of Correction
1
2
3
4
Administrator will follow-up with Corporate to inquire on Relias training.
Type B
Section Cited
CCR
87555(b)(27)
General Food Service Requirements
(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above due to kitchen cabinets having debris, ice cream not being stored properly, defrosting food should be stored to prevent contamination. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2024
Plan of Correction
1
2
3
4
Areas will be cleaned and pictures will be sent to LPA.
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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2