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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208796
Report Date: 07/17/2023
Date Signed: 07/18/2023 02:28:13 PM


Document Has Been Signed on 07/18/2023 02:28 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:APRICOT MORNINGS IIIFACILITY NUMBER:
107208796
ADMINISTRATOR:HURLEY, JACK CFACILITY TYPE:
740
ADDRESS:248 W VERMONTTELEPHONE:
(559) 430-5743
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 6DATE:
07/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Nathalie GakoTIME COMPLETED:
05:00 PM
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On 07/17/2023, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. LPA toured facility with Administrator Nathalie Gako.

Facility has one entrance/exit point. LPA toured facility with Lead staff inside and out. LPA observed residents at common area watching television and waiting for dinner.

The facility was observed to be at a comfortable temperature, free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. Department phone number and infection prevention information signs were posted thought the facility.
Fire extinguisher was observed with a service date of 10/13/202. All six resident's rooms were observed to be with comfortable temperature reading of 75 degrees.

Bathrooms were clean, odor free, and all fixtures were functioning properly. LPA observed two-day supply of perishable food stuffs and seven-day supply of non-perishable food stored in cabinets. Sharp items were secured in a locked drawer in the kitchen.

Medications were locked in a cabinet in the laundry room and LPA reviewed electronic MAR called Alcomy, medications appear to be administered properly. LPA reviewed staff and resident files.



No deficiencies were observed. Exit interview conducted.

Report was signed and copy of this report was provided for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023
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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