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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209169
Report Date: 11/06/2023
Date Signed: 11/06/2023 10:45:30 AM

Document Has Been Signed on 11/06/2023 10:45 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:CARING ANGELSFACILITY NUMBER:
107209169
ADMINISTRATOR:ALCAREZ, RACHELFACILITY TYPE:
735
ADDRESS:1689 SUSSEX AVENUETELEPHONE:
(559) 287-3472
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 4DATE:
11/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee Swellen Medroso and Administrator Rachel AlcarazTIME COMPLETED:
11:00 AM
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On 11/06/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit.
introduce self, stated the purpose of the visit and met Licensee (L1) Swellen Medroso and Administrator (A1) Rachel Alcaraz LPA toured facility with L1 and A1. Two client was 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 or outside. An adequate supply of perishable and
non-perishable food was observed. Fire extinguisher was observed with a service date of: 04/16/23. Fire drill
last completed:10/01/23. The temperature is maintained for refrigerator at 37 degrees F and freezer at 0
degrees F. Medications observed locked in kitchen shelf. MARs were reviewed. Cleaning supplies and chemicals stored and locked under kitchen sink.

All bedrooms were observed to have the required furnishings and with adequate lightening. The bathrooms were toured. Bathrooms were observed operational during inspection. Hot water temperature was tested at 117.7 degree F in the bathroom 1 and 119.8 degree F in master bathroom. Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching. Swimming pool observed locked and inaccessible to clients. Adequate outdoor seatings available for clients. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ files were reviewed to have all the required documents. Staff files were also reviewed to have current First Aid/CPR, Personnel Record, Criminal record Statement, and Health Screening. Staff were fingerprinted cleared and associated with facility.

No deficiency cited during inspection. Exit Interview conducted. The following documents are requested and
submitted to Fresno CCL by: 11/13/23. Forms requested: Lic 308, Lic 309 (if applicable), Lic 500, Lic 610D, Lic 9282, current Administrator certificate, and control of property. A copy of this report and appeal rights was provided to Administrator, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2023
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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