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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206749
Report Date: 02/16/2023
Date Signed: 02/22/2023 04:20:35 PM


Document Has Been Signed on 02/22/2023 04:20 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:CEDARBROOK MEMORY CARE COMMUNITYFACILITY NUMBER:
107206749
ADMINISTRATOR:SARAH DENNISFACILITY TYPE:
740
ADDRESS:1425 E. NEES AVETELEPHONE:
(559) 412-2299
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:68CENSUS: 60DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator, Sarah DennisTIME COMPLETED:
10:05 AM
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On 02/16/2023, Licensing Program Analyst (LPA) V Gorban arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Sarah Dennis.

Facility, with census of 60 residents, appeared cleaned with no obstruction or fire clearance issues. This facility is for long term stay residents. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Fire extinguisher service date on 06/10/2022. Hand washing posters were not observed. Water temperature in bathrooms of 105 degrees is recorded. 12 bedrooms are single occupant. Beds in the shared apartments were observed to be at least 6 feet apart. Each apartment supplied with call light and motion detector for residents’ safety and fall prevention.

LPA checked residents’ locked medications. Facility has a 30-day supply of medications. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Cleaning and chemical supplies are locked in laundry room. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Resident’s files have updated emergency contact and physician report information an.

Exit interview conducted. No deficiencies were found on this visit. Report printed and provided for facility records to Administrator Sarah Dennis.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
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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