107202374-10-12-2023-24-AS-MGAA-CWJNWD-20231012104923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107202374
Report Date: 08/24/2023
Date Signed: 10/12/2023 10:49:28 AM

Document Has Been Signed on 10/12/2023 10:49 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:	NEW LIGHT RESIDENTIAL CARE HOME, THE		FACILITY NUMBER:	107202374
ADMINISTRATOR:	GALVEZ, MARLENE		FACILITY TYPE:	740
ADDRESS:	1322 W. ROBERTS AVE.		TELEPHONE:	(559) 261-9818
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	6	CENSUS: 6	DATE:	08/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Administrator, Carlo Santos		TIME COMPLETED:	05:04 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 8/24/23 Licensing Program Analyst (LPA) M. Garza arrived for an unannounced annual inspection visit. LPA was met by Direct Care Staff, Joseph and Bae Chua. Administrator, Carlo Santos was contacted and arrived some time later. LPA introduced self, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check on residents in care. Residents observed in common area and in rooms. LPA toured the facility inside and out. There was 3 residents on hospice at the time of inspection. Pathways and doors inside facility were clear and free from obstruction. Inside facility was without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors present and operational at time of visit. Fire extinguisher last serviced 9/20/22. Last fire drill on 5/23/23. Water temperature measured 96.2 degrees F in kitchen and 112 degrees F in bathroom #2. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. Sharps kept in a locked cabinet under the kitchen sink, medications kept locked inside a locked cabinet. CONT...

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary Garza	TELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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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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: NEW LIGHT RESIDENTIAL CARE HOME, THE	FACILITY NUMBER: 107202374
	VISIT DATE: 08/24/2023

NARRATIVE

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CONT...

The following issues were observed during the visit: trash cans observed with lids but not closed. Trash can in living room area does not have a lid. Blinds on back room windows observed to be dirty and in disrepair. Side gate does not self latch. Gate tied closed with a metal wire. Patio observed with debris, chemicals and tools. Storage room off patio opened and cluttered. Facility in need of general house keeping for the outside of the facility (clutter/spider webs). Water heater observed to be leaking. Water hose in walkway off patio. Fence boards missing on back fence. Debris behind garage. Garage unlocked and observed with clutter/debris. Chemicals in hallway closet near laundry unlocked. Laundry room unlocked with chemicals accessible. Food in pantry not properly stored. Wood rot under kitchen sink. Restroom door left ajar by staff while in use by resident. Restroom #1 observed dirty around toilet flooring. Oxygen signs not posted on resident doors. 1 of 6 resident rooms observed without bulb in lamp. Water temperature in kitchen measured at 96.2 degree F.

LPA requested the following documents to be submitted to CCL by 8/31/23: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Due to time constraints, LPA will return at a later date for an annual continuation and to cite deficiencies. Exit interview completed with Administrator, Carlo Santos. A copy of this report.

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary Garza	TELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC809 (FAS) - (06/04)

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