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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208983
Report Date: 02/12/2025
Date Signed: 02/12/2025 11:23:53 AM

Document Has Been Signed on 02/12/2025 11:23 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: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: 39DATE:
02/12/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:02 AM
MET WITH:Regional VP of Operations, Dan CormleyTIME VISIT/
INSPECTION COMPLETED:
11:23 AM
NARRATIVE
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On 2/12/25 a Case Management visit is being conducted during the NCC meeting. Present at this meeting was Regional VP of Operations, Dan Gormley, Executive Director, Robert Huntley, Regional Manager, Brenda White, Licensing Program Manager (LPM), See Moua, Licensing Program Analyst (LPA) Mary Garza. This case management is being conducted and associated to complaint #24-AS-20240906130954.

During the investigation additional information was received. During documentation review it was observed that the facility did not obtain medical care for R1 in a timely manner. Deficiencies cited per Title 22. Should civil penalties need to be assessed after further review, they will be cited at a later date.

Exit interview completed with Regional VP of Operations, Dan and Executive Director, Robert. A copy of this report, deficiencies and appeal right provided.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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Document Has Been Signed on 02/12/2025 11:23 AM - It Cannot Be Edited


Created By: Mary Garza On 02/12/2025 at 11:03 AM
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: 02/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2025
Section Cited
CCR
87411(d)(5)

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87411 Personnel Requirements - General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (5) Knowledge necessary in order to recognize early signs of illness and the need for professional help.
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In servive training for all staff will be completed for observation of residents and seeking timely medical attention. In service sign in sheet and training material will be provided to CCL as proof of correction by POC date.
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This requirement was not met as evidence by record review. The licensee did not comply with the section cited above in that the facility did not obtain medical care for R1 in a timely manner, resulting in R1 being placed on hospice and passing. This poses an immediate health, safety and or personal rights risk to persons in care.
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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: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2025


LIC809 (FAS) - (06/04)
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