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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209007
Report Date: 01/22/2024
Date Signed: 01/26/2024 02:25:33 PM


Document Has Been Signed on 01/26/2024 02:25 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:FIVE STAR ASSISTED LIVINGFACILITY NUMBER:
107209007
ADMINISTRATOR:OGANYAN, HASMIK JASMINEFACILITY TYPE:
740
ADDRESS:5727 N. HAZEL AVETELEPHONE:
(818) 261-4887
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 6DATE:
01/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Jasmine Oganyan, AdministratorTIME COMPLETED:
05:00 PM
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On 01/22/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual
Inspection. LPA introduced stated the purpose of the visit and met with Administrator Jasmine Oganyan. LPA toured facility with Administrator. Five residents were present during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Fire extinguisher was observed with a served date: 02/16/23. An adequate supply of perishable and non-perishable food was observed. Knives were observed locked under kitchen sink. Refrigerator temperature observed maintained at 37 degree F and freezer temperature maintained at -1 degree F. Medications were observed kept locked in laundry closet. Cleaning chemicals were observed locked and inaccessible to residents under laundry sink. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured. All bathrooms were observed operating and functioning during inspection. Non-skid mat and grabbed bars were observed. Hot water temperature was tested between range 115 and 113.4 degrees in master bathroom. Hot water temperature was tested at 112.2 in bathroom. Extra linens were observed. Outside of facility toured. Side gate was observed self-closing and free of debris. Adequate outdoor seating available for residents.

Due to time constrain, LPA will return at later date for an Annual continuation inspection.

No deficiencies cited during today’s visit. Exit Interview conducted. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of these report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2024
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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