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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204117
Report Date: 05/17/2024
Date Signed: 05/20/2024 10:11:30 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/20/2024 10:11 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:
05/17/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:14 AM
MET WITH:Administrator, Jose De La CuevaTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 5/17/2024 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced annual continuation visit. LPA was met by Direct Care Staff, Jonathan Escalera, explained reason for visit and was permitted entry into the facility. Administrator was contacted and stated they were unavailable and it was okay to conduct visit with Staff, Jonathan.

LPA completed a health and safety check on residents in care. During time of visit residents were at day program. LPA reviewed sample files:

LPA reviewed Resident 1's file: LPA observed the preplacement appraisal, needs & services plan and IPP, signed physician’s report, signed admission agreement, Identification/Emergency information, restricted health care plan, and records of residents safeguarded log.

LPA reviewed Resident #2's (R2) file: LPA observed preplacement appraisal, needs & services plan and IPP, signed physician’s report, signed admission agreement, Identification/Emergency information, restricted health care plan, and records of residents safeguarded log.

Staff files were inaccessible by Direct Care Staff and not reviewed.

Exit interview completed with Direct Care Staff, Jonathan. A copy of this report was provided.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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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