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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203506
Report Date: 01/23/2023
Date Signed: 01/24/2023 07:50:49 AM

Document Has Been Signed on 01/24/2023 07:50 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:SVS CLOVIS ADULT DAY PROGRAMFACILITY NUMBER:
107203506
ADMINISTRATOR:BANUELOS, CHERIFACILITY TYPE:
775
ADDRESS:155 PARK CREEK DRIVE, #101TELEPHONE:
(559) 323-0537
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 90CENSUS: 56DATE:
01/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Admininstrator, Alex WilliamsTIME COMPLETED:
01:30 PM
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On 01/23/2023, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to conduct an Annual Inspection - Infection Control. LPA met Administrator Alex Williams. 56 clients census during the inspection.

LPA completed a tour of the facility with administrator. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. LPA observed 30-day PPE supply. Client restrooms were tour, observed to be clean, and operational. LPA observed hand washing posting by all sinks. Social distancing is maintained in the common areas. LPA observed social distancing and cough etiquette postings in facility.

The Day Program has five classrooms separated into cohort for activities. Facility is maintained at a comfortable temperature and no passageway obstructions or fire hazards were observed inside or outside. Fire extinguishers with service date of 08/30/2022. Client were observed in the drama and art rooms after lunch. LPA observed locked medications in Administrator office.

A sample of client files were also reviewed to have updated emergency contact information.

No deficiencies were observed or cited

Exit Interview conducted and copy of the report emailed to Administrator.

The following documents are requested and to be submitted to Fresno CCL by: 2/15/23. The following updated forms were requested: Lic 308, Lic 309 (if applicable), Lic 500, Lic 610D, Lic 808 and Lic 9020.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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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