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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209391
Report Date: 04/12/2024
Date Signed: 04/12/2024 03:52:49 PM

Document Has Been Signed on 04/12/2024 03:52 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:SIERRA MEADOWS BEHAVIORAL HEALTHFACILITY NUMBER:
107209391
ADMINISTRATOR/
DIRECTOR:
TATUM, MATTHEWFACILITY TYPE:
772
ADDRESS:8104 E BULLARD AVETELEPHONE:
(559) 326-7775
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY: 16CENSUS: 0DATE:
04/12/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Program Director Amanda FrantzTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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On 04/12/24, Licensing Program Analyst (LPA) V Gorban conducted an announced Pre-licensing visit. LPA met with Program Director Amanda Frantz and discussed the purpose of the visit.

LPA began the tour at the entrance of the facility that has one entrance point. LPA toured the inside and outside of the facility. LPA observed no obstruction to emergency exit from back yard of the facility on west sides.
The facility was observed at a comfortable temperature of 76 degrees Fahrenheit, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas furnished and well-lit throughout. LPA observed the kitchen to be absent of any trash or debris, sharp objects are secured and inaccessible to clients. At this time, seven-day supply of non-perishable food were observed.

Medications and chemicals were kept locked in separate cabinets. Client’s all six bedrooms were observed each to be furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains.
The bathroom’s water temperature was tested at 111 degrees Fahrenheit. Towels, linens, and personal hygiene supplies were observed in storage.
Outdoor seating area observed and functional for clients to utilize. Pool fenced and gate locked for safety.

All Fire extinguishers are current with service date of 09/23/2023. Carbon monoxide and smoke detectors were observed to be operational. First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, required phone numbers, and required postings were observed. A working facility telephone number (559-203-1797) present and functional.

Component III was reviewed with Licensee and Administrator. No deficiencies were observed during this visit. Report will be submitted Centralize Application Bureau for record and further processing of application.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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