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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208930
Report Date: 07/26/2024
Date Signed: 07/28/2024 11:45:09 PM


Document Has Been Signed on 07/28/2024 11:45 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:WINDHAM, THEFACILITY NUMBER:
107208930
ADMINISTRATOR:EARLEY, JOHNFACILITY TYPE:
740
ADDRESS:1100 E SPRUCE AVETELEPHONE:
(559) 449-8070
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:88CENSUS: DATE:
07/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Health & Wellness Director Nancy PultzTIME COMPLETED:
11:30 AM
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On 7/26/24 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a case management. LPA entered the facility, introduced herself, and explained the reason for the visit.
LPA was not able to meet with Administrator John Earley at this time. LPA met with Nancy Pultz.

LPA toured the facility to verify there was no immediate danger.

LPA collected additional documents from R1's chart and documents from R2's chart.



Exit interview was conducted and a copy of this report LIC809 was provided to Nancy Pultz.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024
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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