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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208866
Report Date: 01/22/2025
Date Signed: 01/22/2025 11:28:51 AM

Document Has Been Signed on 01/22/2025 11:28 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:VISTA ELDERLY CARE FACILITYFACILITY NUMBER:
107208866
ADMINISTRATOR/
DIRECTOR:		ABALOS, CORAFACILITY TYPE:
740
ADDRESS:8893 NORTH SIERRA VISTA AVETELEPHONE:
(559) 470-2062
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Staff - Carlos CabigaoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 01/22/2025, Licensing Program Analyst (LPA) M Vega 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 Staff 1 (S1) Carlos Cabigao. Administrator (AD) Sophat Yin was notified of Licensing visit and was not able to attend the visit. Permission to sign document was granted to S1. AD certification number 7028106740 and expiration date 05/08/2026.

8:40 am Facility has one entrance/exit point. LPA toured facility with S1 inside and out. The facility was observed to be at a comfortable temperature, of 73 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. LPA observed some residents in common area after breakfast watching television, others in their rooms resting and 2 residents finishing breakfast in the dining room. Department phone number and infection prevention information signs were posted thought the facility.

9:00 am All 6 residents’ bedrooms were observed to be with comfortable temperature. Bathroom water temperature was tested and recorded reading of 112.6 degrees F. Facility was observed to be odor free.

9:20 am Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed. Knifes and sharp objects were locked in drawer and inaccessible to residents. Medications observed to be locked in a cabinet in the kitchen. Fire extinguisher was observed with a service date of 01/14/2025.


Continuation on LIC 809C
Brenda ChanTELEPHONE: (650) 272-4781
Martin VegaTELEPHONE: 559-243-8080
DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: VISTA ELDERLY CARE FACILITY
FACILITY NUMBER: 107208866
VISIT DATE: 01/22/2025
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LPA reviewed medication records were correct and up to date at time of visit. Cleaning supplies were observed to be in a locked cabinet in the laundry room and under kitchen sink. An outdoor seating area was observed operational for residents in care. Facility toured outside. Exits and walkways free of obstruction. Gate on side of facility was self-latching. Yard is currently free from any obstructions. Garage door from laundry room to garage is locked and inaccessible to residents.

LPA reviewed Staff and Resident files. Resident files observed to have updated information.

No deficiencies were observed and cited.
Exit interview conducted, report was signed and copy of this report was provided for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 272-4781
LICENSING EVALUATOR NAME: Martin VegaTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
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