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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201687
Report Date: 07/06/2023
Date Signed: 07/06/2023 04:41:18 PM


Document Has Been Signed on 07/06/2023 04:41 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:PRYOR FALLS, INC.FACILITY NUMBER:
107201687
ADMINISTRATOR:PINHEIRO, TRISHAFACILITY TYPE:
740
ADDRESS:260 W. LOYOLA AVENUETELEPHONE:
(559) 297-8828
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 5DATE:
07/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator Trisha PinheiroTIME COMPLETED:
11:30 AM
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On 07/06/2023, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. LPA toured facility with Administrator Trisha Pinheiro.

Facility has one entrance/exit point. LPA toured facility with Lead staff inside and out. LPA observed residents at common area having breakfast and watching television.

The facility was observed to be at a comfortable temperature, free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. PPE were observed in a laundry room locked. A 2-day supply of perishable and 7-day supply of non-perishable food was observed to be properly stored and labelled. Fire extinguisher was observed with a service date of 05/30/2023. Resident's all 5 bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting.

Garage is not utilized for any activities or events. Sample of residents file were reviewed.

Exit interview conducted, no deficiencies were observed during this visit.

Report was signed and copy of this report was provided for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
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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