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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201663
Report Date: 01/16/2024
Date Signed: 01/16/2024 02:12:09 PM


Document Has Been Signed on 01/16/2024 02:12 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:SERENITY LIVINGFACILITY NUMBER:
107201663
ADMINISTRATOR:JONES, JOSIANEFACILITY TYPE:
740
ADDRESS:2605 W. BARSTOW AVENUETELEPHONE:
(559) 449-0504
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 3DATE:
01/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Licensee, Josiane JonesTIME COMPLETED:
02:19 PM
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On 1/16/2024 Licensing Program Analyst (LPA) M. Garza completed an unannounced Case Management visit. LPA met with Direct Care Staff, Elaine Salcedo explained reason for visit and was permitted entry into facility. Licensee, Josiane Jones was contacted and informed LPA was present at the facility and the reason for visit. Licensee provided permission for Staff to complete visit and sign report. LPA completed a health and safety check on residents in care. Residents observed in common areas.

During visit LPA collected and removed resident files (3) and an overflow file (1) from facility. Files will be retuned to the facility within 3 business days. No deficiencies cited during todays visit.

LPA conducted an exit interview with Direct Care Staff, Elaine. A copy of this report provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024
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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