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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208908
Report Date: 07/28/2023
Date Signed: 07/31/2023 07:35:48 AM


Document Has Been Signed on 07/31/2023 07:35 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:WESTMONT OF FRESNOFACILITY NUMBER:
107208908
ADMINISTRATOR:ERIK V. SCHUKFACILITY TYPE:
740
ADDRESS:7442 & 7468 N MILLBROOK AVETELEPHONE:
(559) 446-1266
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:155CENSUS: 113DATE:
07/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Erik SchukTIME COMPLETED:
11:30 AM
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 7/28/2023, Licensing Program Analyst (LPA) V Gorban conducted an unannounced Case Management visit the facility that was reported to Licensing on 7/24/23.

LPA introduced self and was allowed entrance by staff. LPA Gorban met with Administrator Erik Schuk.

LPA toured facility inside and out, observed residents in dining room during breakfast. LPA Gorban reviewed facility residents’ files, interviewed staff and administrator. LPA attempted to interview residents R1 and R2.
LPA requested following facility files: staff schedule, residents files, facility policy and procedures, and staff training.

No deficiencies cited during this Case Management visit.

Exit interview was conducted, report signed on-site, and a 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: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2023
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