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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206649
Report Date: 12/20/2022
Date Signed: 12/20/2022 01:20:53 PM


Document Has Been Signed on 12/20/2022 01:20 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:SUNRISE OF FRESNOFACILITY NUMBER:
107206649
ADMINISTRATOR:BREWER, NORSHELLFACILITY TYPE:
740
ADDRESS:7444 N. CEDARTELEPHONE:
(559) 325-8170
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:89CENSUS: 69DATE:
12/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Administrator, Norshell BrewerTIME COMPLETED:
10:31 AM
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On 12/20/2022, Licensing Program Analyst (LPA) V Gorban arrived unannounced at the above facility to conduct an Annual Inspection-Infection Control. LPA introduced self, stated the purpose of the visit and requested to speak with the Administrator. LPA met with Administrator (ADM), Norshell Brewer. Facility has one central entry and exit point. Upon entry, LPA observed visitor log-in/temperature check.

LPA conducted a facility tour with ADM. All pathways, entrances and exits were clear from obstructions. No fire clearance issues. LPA observed signs promoting hand-washing, social distancing, and cough/sneeze etiquette. Facility staff observed to be wearing facial coverings. LPA toured the facility kitchen. LPA observed a 7-day supply of perishable foods and a 2-day supply of perishable foods. LPA observed a 30 day supply of PPE and cleaning supplies. LPA checked residents' medications and observed a 30 day supply. Resident and staff temperature checks are documented daily.

Residents at the above facility have private units, fully furnished, with adequate lighting, comfortable room temperature and bathrooms fully stocked . LPA toured and inspected memory care (16 residents ) and assisted living (53 residents) sections of the facility. Facility LPA observed hand sanitizer dispensers in the facility hallways. Facility bathrooms were stocked with paper towels and liquid soap. Hand-washing signs observed in common bathrooms. Resident records have updated emergency contact information. Personnel records reviewed for good health. Infection control emphasized by placed hand washing signs throughput the facility hallways, bathrooms, kitchen, and main area.

No deficiencies issued during this inspection. Exit interview conducted, report signed on-site and copy of this report provided to ADM for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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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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: SUNRISE OF FRESNO
FACILITY NUMBER: 107206649
VISIT DATE: 12/20/2022
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LPAs are requesting the following documents to be provided to the Fresno CCL office by 01/27/2023: Current copy
Of:

LIC 308 Designation of Facility Responsibility
· -as applicable: LIC 309 Administrative Organization
· -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources
· -as applicable: LIC 402 Surety Bond
· LIC 500 Personnel Report
· LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly
· LIC 9020 Register of Facility Clients/Residents
· Copy of current Liability Insurance
· Copy of current Administrator Certificate
· Alternate contact information including name, telephone number, & email address.


An exit interview was conducted with Administrator. Report signed on-site by Administrator and printed copy
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
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