<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209356
Report Date: 10/04/2023
Date Signed: 10/04/2023 10:40:37 AM

Document Has Been Signed on 10/04/2023 10:40 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:FIELDS FAMILY RESIDENTIAL CAMBRIDGE HOMEFACILITY NUMBER:
107209356
ADMINISTRATOR:FIELDS, CHRISTALFACILITY TYPE:
735
ADDRESS:1036 W CAMBRIDGE AVE.TELEPHONE:
(559) 412-1796
CITY:FRESNOSTATE: CAZIP CODE:
93705
CAPACITY: 4CENSUS: 0DATE:
10/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Antionette Brookins, Licensee
Christal Fields, Administrator
Arlene Stovall, Licensee		TIME COMPLETED:
10:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/4/23 at 8:33 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Pre-Licensing inspection. LPA met with Licensee Antionette Brookins and Administrator Christal Fields. Licensee Arlene Stovall arrived a some time later.

LPA toured the inside and outside of the facility, and did not observe any obstructions. All bedrooms have sufficient furniture and lighting. Linen and toiletries observed. Facility set at comfortable temperature. Smoke and carbon monoxide detectors tested and operational. Dishware and utensils observed. Sharps observed inaccessible in kitchen closet. Centrally stored medication observed designated to locked kitchen closet.

The following observed will need to be brought into compliance:
1. Need updated facility floor plan to more accurately depict the facility layout, to include doors, windows, and closets.
2. Designated centrally stored medication cabinet currently has chemicals and paint cans stored in the cabinet.
3. Facility Plan of Operation, copy of Admission Agreement, and sample food menu to be available for review.
4. Designated lock box or drawer with lock needed for sharps.

Componenet III completed. A follow-up inspection to be scheduled once all above items are in compliance. Exit interview conducted.

A copy of this report was given to Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1