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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204206
Report Date: 02/26/2024
Date Signed: 02/26/2024 04:25:29 PM


Document Has Been Signed on 02/26/2024 04:25 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:APRICOT MORNINGS RESIDENTIAL LIVING IIFACILITY NUMBER:
107204206
ADMINISTRATOR:ANNABELLE J HURLEYFACILITY TYPE:
740
ADDRESS:993 NORTH KARENTELEPHONE:
(559) 325-5673
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 6DATE:
02/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Assistant Administrator Natalie Gako TIME COMPLETED:
04:30 PM
NARRATIVE
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On 02/26/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit.
introduce self, stated the purpose of the visit and met caregiver John Ramirez. LPA toured facility with caregiver. Administrator Jack Hurley was called. Assistant Administrator (AA) Natalie Gako arrived shortly during tour. LPA our facility with AA. All six residents were present during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair were observed inside or outside. Secure lock above top front door was observed. Medications were observed locked in kitchen shelves. MARs were reviewed. Extra linens were observed. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature is maintained at 40 degrees F and freezer at 0 degrees F. Fire extinguisher was observed with a service date of: 8/3/24. Cleaning supplies and chemicals stored and locked in garage and laundry room. Washer and dryer observed operational during inspection. Laundry detergent observed unlock in the garage. All bedrooms were observed to have the required furnishings and with adequate lightening. LPA observed in resident bedroom 3 with child locked doorknob. The bathrooms were toured and observed operational during inspection. Non-skid mat and grabbed bars were observed. Hot water temperature was tested at 115.7 in the bathroom 1, 105.4 in room 2 bathroom, 110.2 in room 6 bathroom, and 105.4 in room 1 bathroom. Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching. Adequate outdoor seatings available for residents. Carbon monoxide and smoke detectors were tested and observed to be operational. Half of the residents’ and 3 staff files were reviewed to have all the required documents.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. A copy of this report and appeal rights was provided to Administrator, whose signature on this form confirms receipt of this report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024
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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Document Has Been Signed on 02/26/2024 04:25 PM - It Cannot Be Edited

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: APRICOT MORNINGS RESIDENTIAL LIVING II
FACILITY NUMBER: 107204206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87705(f)(2)
87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed at approximately 02:34PM, laundry detergents and bleach unlock in the garage and laundry room. LPA observed an alcohol bottle on under kitchen counter unlock and accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2024
Plan of Correction
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Staff immediately removed chemicals into locked cabinet in the garage. POC cleared during visit.
Type A
Section Cited
CCR
87203
87203 All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed a child lock doorknob attached to R3’s bedroom doorknob and a secure metal lock an the very top of the front door which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2024
Plan of Correction
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Staff removed child look doorknob from R3’s bedroom doorknob and metal lock from front door during visit. POC cleared during visit.
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 MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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