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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202593
Report Date: 12/09/2022
Date Signed: 12/09/2022 04:20:44 PM

Document Has Been Signed on 12/09/2022 04:20 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:EDDIE'S TERRACE #7FACILITY NUMBER:
107202593
ADMINISTRATOR:HENDRICKS, STEPHANIEFACILITY TYPE:
735
ADDRESS:1837 SOUTH BUSH AVENUETELEPHONE:
(559) 252-7811
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 4DATE:
12/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator Shameka TurnerTIME COMPLETED:
04:20 PM
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On 12/09/22, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA met with care staff Lisa Beck and stated the purpose of the visit.
Administrator Maricia Alvarado was contacted and would be arriving shortly.

Visitor log-in/temperature check, masks, and disinfection station were observed upon entry. Facility has one
entrance/exit point. Facility staff observed with facial coverings. Facility appeared clean with no obstruction or
fire clearance issues. Hand sanitizer was readily available to residents and visitors. Hand washing and other
various Covid-19 related signs were observed in the common areas. During inspection LPA received a call from Administrator Maricia Alvarado stating she was unable to come to the facility and would be sending Administrator Shameka Turner

Sharp items and medication were locked in the kitchen area in a cabinet. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in the kitchen was last serviced on 11/1/2022 and was fully charged. Additional cleaning supplies kept locked in garage. Hand washing posters were observed in the bathrooms by the sink. A sample of medication was reviewed. Staff and resident records were reviewed for updated emergency contact information and first aid training.

No deficiencies were observed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 12/16/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610E), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with staff. Report signed on-site by staff and printed copy provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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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