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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208983
Report Date: 01/07/2025
Date Signed: 01/07/2025 06:11:14 PM

Document Has Been Signed on 01/07/2025 06:11 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:SUMMERFIELD OF FRESNOFACILITY NUMBER:
107208983
ADMINISTRATOR/
DIRECTOR:		GALINDO, BERONICAFACILITY TYPE:
740
ADDRESS:6075 N. MARKSTELEPHONE:
(559) 446-6226
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 64CENSUS: 40DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:37 AM
MET WITH:Executive Director, Beronica GalindoTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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On 1/7/24 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Executive Director, Beronica Galindo. LPA introduced self, explained reason for visit and was permitted entry into the facility.

LPA completed a health and safety check on residents in care. LPA toured the facility inside and out. Residents observed in common areas and in rooms. There was 10 residents on hospice at the time of the inspection. Pathways and doors were clear and free from obstruction. Facility was clean and without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operate on a system. Fire extinguisher last serviced 09/12/24. Last fire drill conducted on 12/17/24. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. Sharps and chemicals were located in locked closets/rooms. LPA observed sufficient seating under covered patio areas.

The following issues were observed during todays visit: personal rights, additional personal right, non-discrimination and complaint information not posted. Room #407 observed with sagging mattress in need of replacement. Carpet in Apple kitchenette torn at transition observed in need of repair. Apple kitchenette cabinet handle broken and in need of repair. Room #310 toilet in need of cleaning. Chemicals observed in resident room #210 unlocked and accessible. Sidewalk in courtyard in need of debris removal. Hand railing in Garden wing in need of cleaning. Refrigerator/freezer in Garden wing in need of cleaning/repair. Spider webs observed throughout the facility in need of removal. Touch up paint needed in hallways in Garden wing. Seaside kitchenette flooring sticky and in need of cleaning. Wall in room #428 in need of patching/touch up. CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SUMMERFIELD OF FRESNO
FACILITY NUMBER: 107208983
VISIT DATE: 01/07/2025
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CONT...

LPA requested the following documents to be submitted to CCL by 1/17/25 : current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Exit interview completed with Executive Director, Beronica. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
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Document Has Been Signed on 01/07/2025 06:11 PM - It Cannot Be Edited


Created By: Mary Garza On 01/07/2025 at 05:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SUMMERFIELD OF FRESNO
FACILITY NUMBER: 107208983

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(c)
87309 Storage Space and Access
(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation of chemicals observed in room #210 unlocked and accessible to resident in care. This poses a potential health, safety and or personal rights risk to residents in care.
POC Due Date: 01/17/2025
Plan of Correction
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Executive Director stated the physicians report (LIC 602) will be updated. Care givers will be provided in-service training. In service sign in sheet and training material to be provided to CCL by POC date
Type B
Section Cited
CCR
87303(a)
87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations of Room #407 observed with sagging mattress in need of replacement. Carpet in Apple kitchenette torn at transition observed in need of repair. Apple kitchenette cabinet handle broken and in need of repair. Room #310 toilet in need of cleaning. This poses a potential health safety and or personal rights risk to residents in care. Sidewalk in courtyard in need of debris removal. Handrailing in Garden wing in need of cleaning. Refrigerator/freezer in Garden wing in need of cleaning/repair. Spider webs observed throughout the facility in need of removal. Touch up paint needed in hallways in Garden wing. Seaside kitchenette flooring sticky and in need of cleaning. Wall in room #428 in need of patching/touch up. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Executive Director stated corrections will be completed to the above issues. CCL will be provided pictures as proof of corrections once items are corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
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