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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201415
Report Date: 01/05/2023
Date Signed: 01/05/2023 10:03:40 AM


Document Has Been Signed on 01/05/2023 10:03 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:ROYAL GARDENS IIFACILITY NUMBER:
107201415
ADMINISTRATOR:AULAKH, GURMITFACILITY TYPE:
740
ADDRESS:4238 E. ALAMOS AVENUETELEPHONE:
(559) 226-3320
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: 5DATE:
01/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Administrator Gurmit AulakhTIME COMPLETED:
10:30 AM
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On 1/05/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection -Infection Control. LPA met with Administrator Gurmit Aulakh and stated the
purpose of the visit.

Visitor log-in/temperature check, masks, and disinfection station were not observed upon entry. Facility has
one entrance/exit point. Facility staff observed without facial coverings. Facility appeared clean with no
obstruction or fire clearance issues. Hand washing and other various Covid-19 related signs were observed in the common areas.

Sharp items are kept locked in the kitchen. cleaning supplies were secured in a locked in garage. Medications
were secured and locked in the medication closet in the Hallway. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in the Living room was last serviced on 2/23/2022 and was fully charged. Cleaning and PPE supplies were locked in the garage. Bathrooms have trash cans without lids.
Hand washing posters were observed in the bathrooms by the sink. Staff records were reviewed for good
health and CPR/First Aid training. Resident’s files have updated emergency contact information.

No deficiencies were observed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 1/12/2023: Current copy
of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC
309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster (LIC610E)

An exit interview was conducted with Administrator. Report signed on-site and printed copy provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2023
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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