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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202573
Report Date: 12/01/2023
Date Signed: 12/01/2023 10:01:54 AM

Document Has Been Signed on 12/01/2023 10:01 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:
12/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Lupe and Dale MartinezTIME COMPLETED:
10:05 AM
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On 12/1/2023 Licensing Program Analyst (LPA) M. Garza and Licensing Program Manager (LPM) S. Moua arrived at facility for an unannounced case management visit. LPA and LPM contacted Licensee, Lupe and Dale Martinez who arrived a short time later. LPA and LPM discussed reason for visit and were permitted into the facility. LPA and LPM completed a tour of the facility inside and out. Residents were at day program during time of visit.

This case management visit was conducted for a Special Incident Report (SIR) received on 11/27/2023. SIR stated the facility was in the process of completing a renovation of the facility. The anticipated completed date was noted as 12/1/23. At this time, the facility is extending the anticipation date of completion to 12/15/2023.

No deficiencies cited during today's visit. Exit interview completed with Licensees Lupe and Dale Martinez. A copy of this report was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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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