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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209255
Report Date: 10/02/2023
Date Signed: 10/02/2023 10:58:14 AM

Document Has Been Signed on 10/02/2023 10:58 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:DNA RESIDENTIAL CAREFACILITY NUMBER:
107209255
ADMINISTRATOR:GUZMAN-RIOS, ROSAFACILITY TYPE:
735
ADDRESS:5271 E. GARRETT AVETELEPHONE:
(559) 473-5619
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY: 4CENSUS: 4DATE:
10/02/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee Aaron Gallegos and Administrator Rosa Guzman-Rios TIME COMPLETED:
11:10 AM
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On 10/02/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a required annual inspection. LPA introduce self, stated the purpose of the visit and met Licensee (L1) Aaron Gallegos and Administrator (A1) Rosa Guzman-Rios. LPA toured facility with L1 and A1. No client was present during inspection.

The tour started in the kitchen into the common areas, to the client’s bedrooms, and bathrooms. 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. Temperature maintained for refrigerator at 38 degrees F and freezer at -10 degrees F. Cleaning supplies and chemicals stored and locked under kitchen sink and in garage cabinet. Medications observed kept locked in kitchen shelf. MARs were reviewed. First Aid kit observed with all required documents. Fire extinguisher was observed with a service date of: 04/20/23. Fire drill last completed:09/28/23. All bedrooms were observed to have required furnishings and with adequate lightening. Bathrooms were properly equipped, and the hot water temperature was tested at 106.4 degrees in bathroom 1 and 115.7 degrees F in master bathroom. Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching. Adequate outside seatings observed available for clients. All clients’ file reviewed to have update emergency contacts, Admission agreement, and Pre-Appraisal. Three staff files were also reviewed. Staff files were observed to have current First Aid/CPR, fingerprinted clear and associated to the facility. Carbon monoxide and smoke detectors were tested and observed to be operational.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 10/09/23. Forms requested: Lic 400, Lic 402, Lic 500, Lic 610D, control of property, and current Administrator certificate. A copy of this report was provided to Licensee whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
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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