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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202573
Report Date: 11/20/2024
Date Signed: 11/20/2024 06:11:56 PM

Document Has Been Signed on 11/20/2024 06:11 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:REEDLEY HOMEFACILITY NUMBER:
107202573
ADMINISTRATOR/
DIRECTOR:		LUPE MARTINEZFACILITY TYPE:
735
ADDRESS:3461 S. USRY AVENUETELEPHONE:
(559) 638-6640
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 6CENSUS: 6DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:03 PM
MET WITH:Licensee, Lupe MartinezTIME VISIT/
INSPECTION COMPLETED:
06:20 PM
NARRATIVE
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 On 11/20/24 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived for an unannounced annual inspection visit. LPAs were met by Direct Care Staff, Monica Martinez explained reason or visit and were permitted entry into the facility. Administrator, Dale Martinez was contacted and arrived a short time later. Licensee, Lupe Martinez arrived shortly after.

LPA toured the facility inside and out. A health and safety check was completed on residents in care. 4 of 6 residents present during visit. Residents observed in common areas. Pathways and doors were clear and free from obstruction. Facility was clean and without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 05/22/2024. Last fire drill conducted on 10/28/24. 3 of 4 resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closet in restroom and linen closet in back bedroom. Sharps and medications were located in locked cabinets. Water temperature measured at 116.1 degrees F in restroom #2.

The following issues were observed during todays visit: Side door in need of molding. Patio in back of house under construction and observed with hole exposed side of house stucco. Chemicals/items posing a hazard to residents in care observed in unlocked storage shed, unlocked storage room in hallway with chemicals/items posing a hazard, and hallway closet storing chemicals unlocked and accessible to residents in care. Light outside shed observed without cover. Bedroom #1 observed with dresser missing knobs and in need of repair. Bedroom #3 observed without dresser.

CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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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: REEDLEY HOME
FACILITY NUMBER: 107202573
VISIT DATE: 11/20/2024
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CONT...

LPA requested the following documents to be submitted to CCL by 11/27/24: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Deficiencies cited on 809D per Title 22. Tv's and TA provided. Exit interview completed. A copy of this report, deficiencies, TV's, TA and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/20/2024 06:11 PM - It Cannot Be Edited


Created By: Mary Garza On 11/20/2024 at 05:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: REEDLEY HOME
FACILITY NUMBER: 107202573

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that Side door in need of molding. Patio in back of house under construction and observed with hole exposed the side of house stucco. Light outside shed observed without cover. Bedroom #1 observed with dresser missing knobs and in need of repair. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2024
Plan of Correction
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Licensee stated corrections will be completed. Pictures will be provided to CCL by POC date as proof of correction.
Type B
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that Chemicals/items posing a hazard to residents in care observed in unlocked storage shed, unlocked storage room in hallway and hallway closet storing chemicals unlocked and accessible to residents in care. This posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2024
Plan of Correction
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Licensee will lock up all chemicals/items posing a hazard to residents in care. Pictures will be provided to CCL by POC date as proof of corrections.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2024


LIC809 (FAS) - (06/04)
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