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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204168
Report Date: 11/16/2024
Date Signed: 11/16/2024 12:24:45 PM

Document Has Been Signed on 11/16/2024 12:24 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:MANNING HOMEFACILITY NUMBER:
107204168
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, LUPEFACILITY TYPE:
735
ADDRESS:767 MANNING AVENUETELEPHONE:
(559) 638-9804
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 6CENSUS: 0DATE:
11/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:18 AM
MET WITH:Administrator, Lupe MartinezTIME VISIT/
INSPECTION COMPLETED:
12:34 PM
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On 11/16/24 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA contacted Administrator, Dale Martinez. Licensee, Lupe Martinez, Administrator and Direct Care Staff, Kyrstyn Martinez arrived at the facility. LPA explained reason for visit and was permitted entry into the facility. There are currently no residents residing at the facility.

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 were present and operational at time of visit. Water temperature measured at 116.4 degrees F. Resident rooms observed to have the required furnishings and with adequate lighting.

LPA requested the following documents to be submitted to CCL by 11/22/24: 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) in order to update the facility file.

No deficiencies were cited during todays visit.Exit interview completed with Licensee, Administrator and Direct Care Staff. A copy of this report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2024
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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