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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107207113
Report Date: 01/17/2025
Date Signed: 01/17/2025 01:21:54 PM

Document Has Been Signed on 01/17/2025 01:21 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:BONAVENTE HOME FOR THE ELDERLY #2FACILITY NUMBER:
107207113
ADMINISTRATOR/
DIRECTOR:		BONAVENTE, NIDAFACILITY TYPE:
740
ADDRESS:6097 HARRISONTELEPHONE:
(559) 313-9052
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:39 AM
MET WITH:Designee, Leticia AldanaTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
NARRATIVE
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On 1/17/25 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced case management visit. LPA met with Direct Care Staff (Designee), Leticia Aldana. LPA completed tour of facility inside and out. A health and safety check on residents in care. 1 resident present during time of visit. Resident observed in living room.

This case management visit is being conducted to follow up a previous visit made on 12/26/24. During today's visit the following issues were observed:

The facility does not have activities for the residents to do. Dishwasher non-functioning. Pool non-functioning & has dirty water. Mattress in R1's bedroom in need of replacement. R1's bedroom in need of touch up paint (near bed & near closet). Bedroom #2 restroom has broken tiles. Laundry room observed with holes in wall. Vent in laundry room in need of cleaning. Bedroom #3 door in need of repair. Bathroom #2 observed with bathtub and sinks in need of resurfacing. Bathroom #2 cabinets in need of repair or replacement. Bathroom #2 toilet missing toilet cover. Bathroom #3 in need of paint around toilet. Backyard patio roof observed with holes in need of repair. Garage observed with debris in need of removal. Large left side gate broken and in need of repair. Wires exposed on HVAC unit in need of repair. Right side gate does not latch properly and observed with broken board in need of repair. Driveway observed with missing concrete in need of repair. Kitchen observed with spider webs/dust above stove. Kitchen tiles broken and in need of replacement near sink and on counter.

Deficiencies cited per Title 22.

A copy of this report and appeal rights provided.
See MouaTELEPHONE: (559) -580-4596
Mary GarzaTELEPHONE: 559-365-9009
DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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 2
Document Has Been Signed on 01/17/2025 01:21 PM - It Cannot Be Edited

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: BONAVENTE HOME FOR THE ELDERLY #2
FACILITY NUMBER: 107207113

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2025
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: (1) Socialization, achieved through activities such as group discussion and conversation, recreation, arts, crafts, music, and care of pets.
Deficient Practice Statement
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POC Due Date: 01/27/2025
Plan of Correction
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Administrator stated they will generate a schedule for activites to include the resdents in. A copy will be submitted to CCL by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See MouaTELEPHONE: (559) -580-4596
Mary GarzaTELEPHONE: 559-365-9009

DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2025

LIC809 (FAS) - (06/04)
Page: 2 of 2