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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206544
Report Date: 12/21/2023
Date Signed: 12/22/2023 01:02:15 PM


Document Has Been Signed on 12/22/2023 01:02 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:REHABILITATION CENTRE OF FRESNOFACILITY NUMBER:
107206544
ADMINISTRATOR:BAINS, AMANFACILITY TYPE:
740
ADDRESS:1665 M STTELEPHONE:
(559) 268-5361
CITY:FRESNOSTATE: CAZIP CODE:
93721
CAPACITY:70CENSUS: 40DATE:
12/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Administrator, Aman BainsTIME COMPLETED:
12:41 PM
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On 12/21/23 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Administrator, Aman Bains. 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. LPA toured the facility. Residents observed in common areas and in rooms. There was 1 resident on hospice at the time of the inspection. 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 on a system. Fire extinguisher last serviced 11/16/23. Last fire drill on 12/19/23. Water temperature measured 115.5 degrees F. Medications located in locked in medication carts.

The following issues were observed during visit: Resident rooms did not have the required furnishings. Chemicals observed in an unlocked housekeeping closet. Let Us Know posting not the required size.

LPA requested the following documents to be submitted to CCL by 12/28/23: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

TA's provided for issues observed. No deficiencies were cited during the inspection. Due to time constraints, LPA will return at a later date for an annual continuation. Exit interview completed with Administrator, Aman Bains. A copy of this report and TA's were provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023
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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