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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206749
Report Date: 01/09/2025
Date Signed: 01/09/2025 03:20:56 PM

Document Has Been Signed on 01/09/2025 03:20 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CEDARBROOK MEMORY CARE COMMUNITYFACILITY NUMBER:
107206749
ADMINISTRATOR/
DIRECTOR:
SARAH DENNISFACILITY TYPE:
740
ADDRESS:1425 E. NEES AVETELEPHONE:
(559) 412-2299
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 68TOTAL ENROLLED CHILDREN: 0CENSUS: 61DATE:
01/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Executive Director - Emily Venegas TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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LPA M Vega conducted case management visit to follow-up on an incident report submitted to licensing,LPA spoke with Executive Director - Emily Venegas about incident, in which it was reported that Client #1 was administered a medication during the PM medication pass. Staff #1 reported this immediately and the client's Physician was notified. Client was placed on observation with no issues observed. Resident's responsible party was also notified. Kayleen - Regional Nurse stated that Staff #1 was was disciplined and retrained on medication administration. Kayleen (RN) stated that staff is has taken this additional in person training. Resident was not reported to have had any adverse reactions.

Copy of training was provided to LPA.

No deficiencies were cited because immediate and appropriate action was taken. A copy of this report was provided to Executive Director.
Brenda ChanTELEPHONE: (650) 272-4781
Martin VegaTELEPHONE: 559-243-8080
DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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