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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208835
Report Date: 06/06/2023
Date Signed: 06/07/2023 02:18:23 PM


Document Has Been Signed on 06/07/2023 02:18 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:CREST POINTE ASSISTED LIVING-PRESCOTTFACILITY NUMBER:
107208835
ADMINISTRATOR:KEENE, ALICIAFACILITY TYPE:
740
ADDRESS:2855 PRESCOTT AVENUETELEPHONE:
(559) 765-4321
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 4DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator, Alicia KeeneTIME COMPLETED:
04:50 PM
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On 06/06/2023, 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. Administrator, Alicia Keene assisted Licensing with annual inspection.

LPA toured facility inside and out. LPA observed residents in common area playing games and watching television. Facility has one entrance/exit point. Hand washing and other various infection prevention related signs were observed in the common areas. Facility has sufficient amount of PPE. 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. A 2-day supply of perishable and 7-day supply of non-perishable food was observed. Fire extinguisher was observed with a service date of 07/22/2022. Resident's all 6 bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting.
Garage is not utilized for any activities or events. Sample of residents file was reviewed.

No deficiencies were observed.

Exit interview conducted, report signed and copy of this report provided to Administrator Alicia Keene for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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