<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204117
Report Date: 04/26/2024
Date Signed: 04/29/2024 10:13:15 AM

Document Has Been Signed on 04/29/2024 10:13 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:REYES RANCH LLCFACILITY NUMBER:
107204117
ADMINISTRATOR/
DIRECTOR:		JOSE DE LA CUEVAFACILITY TYPE:
735
ADDRESS:20022 EAST AMERICAN AVETELEPHONE:
(559) 637-0364
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 4CENSUS: 4DATE:
04/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:59 AM
MET WITH:Lead Staff, Lynda SanfordTIME VISIT/
INSPECTION COMPLETED:
03:07 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/26/24 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Lead Staff, Lynda Sanford and Program Support Specialist, Amber Rubio. LPA introduced self, explained reason for visit and was permitted entry into the facility.

LPA completed a health and safety check on residents in care. 4 of 4 residents attending program at time of visit. LPA toured the facility inside and out. 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 present and operational at time of visit. Fire extinguisher last serviced 6/15/23. Last fire drill on 2/4/24. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in staff restroom cabinet. Sharps are kept in locked kitchen drawer. Chemicals kept in bathroom cabinets. Medication kept locked kitchen cabinet. LPA observed sufficient seating under covered area.

LPA requested the following documents to be submitted to CCL by 5/3//24: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 04/29/2024 10:13 AM - It Cannot Be Edited


Created By: Mary Garza On 04/26/2024 at 02:29 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: REYES RANCH LLC
FACILITY NUMBER: 107204117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on LPA observations of sharps, chemicals and medications located in various places around the facility observed. The licensee did not comply with the section cited above in that these items were unlocked and accessible to residents in care. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2024
Plan of Correction
1
2
3
4
Staff to immediately remove all items posing a danger to residents in care and place them where they are inaccessible to residents. Picture will be provided to CCL as verification of items being locked. Training to be completed with all staff on regulations. In-service sign in sheet and trianing material to be provided to CCL by POC date.
Type B
Section Cited
CCR
80087(a)

(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
1
2
3
4
Based on LPA's observations, the licensee did not comply with the section cited. Paper towels in bathroom #2 not on stand. Gap in between door and door frame needing to be filled in bathroom #1. Smoke detector hanging in R1's bedroom. Bedding in R1's room in disrepair and missing mattress cover. 2 of 3 bathroom trash cans without lids. Bathroom #3 has rusted shower curtain rod. R2's dresser missing drawer handle. Food not properly stored/labeled/dated. Kitchen sink cabinet observed with water damage. R4's box spring broken and causing mattress to sag. Outside pantry appears to have water damage/wood rot in entry way. Bench to left of pool is missing seat showing exposed metal legs. Drainage pipe near pool area laying on floor and potential tripping hazard. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2024
Plan of Correction
1
2
3
4
Licensee will correct all issues listed above. Pictures to CCL as verification of correction. All staff to be provided in service training on regulation. In service sign in sheets and training material to be provided to CCL by POC date.
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: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
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: REYES RANCH LLC
FACILITY NUMBER: 107204117
VISIT DATE: 04/26/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONT...


The following issues were observed during visit: Sharps, chemicals and medications located in various places around the facility observed to be unlocked and accessible to residents in care. Paper towels in bathroom #2 not on stand. Gap in between door and door frame needing to be filled in bathroom #1. Smoke detector hanging in R1's bedroom. Bedding in R1's room in disrepair and missing mattress cover. 2 of 3 bathroom trash cans without lids. Bathroom #3 has rusted shower curtain rod. R2's dresser missing drawer handle. Food not properly stored/labeled/dated. Kitchen sink cabinet observed with water damage. R4's box spring broken and causing mattress to sag. Outside pantry appears to have water damage/wood rot in entry way. Bench to left of pool is missing seat showing exposed metal legs. Drainage pipe near pool area laying on floor and potential tripping hazard.

Deficiencies cited on 809D per Title 22. Due to time constraints, LPA will return at a later date for an annual continuation. Exit interview completed with Lead Staff, Lynda and Program Support Specialist, Amber. A copy of this report, deficiencies and appeal right provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3