<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107207113
Report Date: 12/14/2023
Date Signed: 01/04/2024 09:18:22 AM


Document Has Been Signed on 01/04/2024 09:18 AM - 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:BONAVENTE HOME FOR THE ELDERLY #2FACILITY NUMBER:
107207113
ADMINISTRATOR:BONAVENTE, NIDAFACILITY TYPE:
740
ADDRESS:6097 HARRISONTELEPHONE:
(559) 313-9052
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 5DATE:
12/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Administrator, RoseMarie RiemerTIME COMPLETED:
11:11 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/14/23 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met with Direct Care Staff, Leticia Aldana. LPA introduced self, explained reason for visit and was permitted entry into the facility. Administrator, RoseMarie Riemer was contacted and provided permission to complete visit with Staff, Leticia. Administrator arrived at end of visit.

LPA completed a health and safety check on residents in care. LPA toured the facility inside and out. 1 residents observed in their room at time of visit. 4 of 5 residents at day program at time of visit per staff. 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 at time of visit. Fire extinguisher last serviced 1/18/23. Last fire drill on 9/20/23. Water temperature measured 119.6 degrees. 2 of 4 resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. Sharps are kept in locked box in kitchen. Chemicals are kept in the locked garage and medications were located cupboard. LPA observed sufficient seating under covered patio areas.

The following issues were observed during visit: Facility observed with spider webs outside the front and back of the house. Transition strip from the kitchen to the dining room is broken. Side gates are not self-latching. Back door window frame broken. Freezer in garage needs to be defrosted. Light cord in bedroom #3 broken. 2 of 4 bedrooms observed without a night stand.

LPA requested the following documents to be submitted to CCL by 12/21/23: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

No deficiencies were cited during the inspection. TA's provided for the above issues. Due to technical issues, LPA will return at a later date for an annual continuation and to address issues listed above. Exit interview completed with Administrator, RoseMarie Riemer. A copy of this report was provided via email due to technical issues.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1