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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209263
Report Date: 08/01/2023
Date Signed: 08/02/2023 01:41:01 PM


Document Has Been Signed on 08/02/2023 01:41 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:A PLACE CALLED HOME RESIDENTIAL CARE A2FACILITY NUMBER:
107209263
ADMINISTRATOR:MURCHISON, COLINFACILITY TYPE:
740
ADDRESS:1851 N TWINBERRY AVETELEPHONE:
(559) 213-7251
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:1CENSUS: 0DATE:
08/01/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Administrator, Colin MurchisonTIME COMPLETED:
10:30 AM
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On 08/01/23, Licensing Program Analyst (LPA) V Gorban conducted an announced Pre-licensing visit. LPA conducted the inspection with Administrator Colin Murchison, (certification number 6035094740 and certification expiration date 05/06/2025).

A tour inside and outside of the facility was conducted. Resident’s room have adequate furnishings and lighting and all the required furnishings (bed, chair, light, and dresser). Mattress and linen appeared to be in good condition. Home is fire cleared for one ambulatory resident. LPA observed a supply of extra bed linens. Bathroom is properly equipped, and trash can has a fitting lid.

Hot water temperature was observed to be 115 degrees F. Kitchen observed to have dishes, plates, utensils. Sharps/knives and medications are locked in the closet. Cleaning supplies are stored and locked. First aid kit contains all the required items. Fire extinguisher is present and was serviced on 02/09/23, smoke detectors and carbon monoxide are combined in one unit and operating properly.

Outside of the facility toured. Exits open free of obstruction. Gate is self-latching. No outside hazards observed.

All required postings are posted. Facility phone number is 559-908-6306.

Component III conducted during pre-licensing inspection.

LPA have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

Pre-Licensing is complete, and this facility has no deficiencies.

Exit interview conducted, report is signed and copy of the report left with facility administrator Colin Murchison.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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