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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202573
Report Date: 11/21/2022
Date Signed: 11/29/2022 10:38:16 AM

Document Has Been Signed on 11/29/2022 10:38 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:REEDLEY HOMEFACILITY NUMBER:
107202573
ADMINISTRATOR:LUPE MARTINEZFACILITY TYPE:
735
ADDRESS:3461 S. USRY AVENUETELEPHONE:
(559) 638-6640
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 6CENSUS: 6DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:22 PM
MET WITH:Administrator, Dale MartinezTIME COMPLETED:
03:38 PM
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On 11/21/22, Licensing Program Analyst (LPA) M. Garza arrived at the facility unannounced to conduct an Infection Control/Annual Inspection. LPA contacted Administrator who arrived at the facility a short time later. LPA was greeted by Administrator, Dale Martinez and Program Director, Kyrstyn Martinez. LPA stated the purpose of the visit and was allowed entry into the facility. LPA entered through a central entry point and observed a screening sign-sheet and PPE precautionary measures in place.

Administrator completed tour of facility inside and out with LPA. Clients were at program during visit. Infection control postings were observed. Furniture in common areas are spaced to promote physical distancing. A supply of PPE is located in the hallway closet. The 30 day supply is located at nearby office location. Hand washing postings were observed at hand washing stations.

Fire Extinguisher last serviced 5/19/2022. Water temperature measured at 105 degrees F. LPA observed a first aid kit with all the required items. LPA requested the following updated forms by 12/02/22: LIC 308, LIC 309, LIC 500, LIC 610D, and LIC 9020.

No deficiencies cited during todays visit. Exit interview completed with Administrator, Dale Martinez and Program Director, Kyrstyn Martinez and Administrator, Lupe Martinez. A copy of this report was given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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