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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209303
Report Date: 01/25/2024
Date Signed: 01/26/2024 05:11:56 PM

Document Has Been Signed on 01/26/2024 05:11 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:PSALMS 23 LOVING CARE RESIDENTIAL IIIFACILITY NUMBER:
107209303
ADMINISTRATOR:COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:441 W ALLUVIAL AVETELEPHONE:
(559) 270-3822
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY: 4CENSUS: 1DATE:
01/25/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Licensee I'isha CooleyTIME COMPLETED:
01:43 PM
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On 1/25/2024, Licensing program analyst (LPA) V Gorban visited the facility to conduct health and safety checks on clients in care. LPA introduced self, stated the purpose of the visit, and met with facility staff Kenya Carter, Licensee I'isha Cooley was notified of Licensing visit and was able to attend it.

During this visit LPA toured outside and inside of the facility. Interview facility Administrator and staff.

LPA also requested facility files for review and recorded facility images to file.

During this visit no deficiencies were observed or cited.

Exit interview conducted, report signed and copy of this report provided to AD for facility records.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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