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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209413
Report Date: 04/25/2024
Date Signed: 04/25/2024 01:16:14 PM


Document Has Been Signed on 04/25/2024 01:16 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:JOY IN CARING IIFACILITY NUMBER:
107209413
ADMINISTRATOR:IDUSUYI, INNOCENTFACILITY TYPE:
740
ADDRESS:2731 BUCKINGHAM AVETELEPHONE:
(559) 387-4491
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:5CENSUS: 0DATE:
04/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Innocent IdusuyiTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) K.Kaur conducted a Pre-licensing Inspection on this date. LPA met with Licensee Innocent Idusuyi. A tour of the facility was conducted together. This is a new facility with no residents in care. The facility was observed to be at a comfortable temperature, clean, and in good repair. No passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. The dining room is equipped with a table and chairs, living room is equipped with adequate sofas and chairs for residents. Front den has additional seating. Adequate outside space for rest and recreational under a covered patio. Gate is self-closing and self-latching.

Perishable and non-perishable food supply appeared adequate. Knives/ sharps will be locked in the kitchen cabinets under the microwave. Medication will be locked in a cabinet next to dinning room. Cleaning and Chemical supplies will also be kept locked in cabinet in the garage. Residents' bedrooms were observed to be adequately furnished with bed, dresser, chair and adequate lighting. Mattresses and linen were in good condition. Extra linen and towels are available. Hot water temperature measured at 115 degrees F. Carbon monoxide and smoke alarm detectors installed and operational. Bathrooms have grab bars installed in shower. Toilet equipped with toilet safety rail. Non-skid mats in place, hand soap and paper towels available for use. Trash cans with tight fitting lids are in place. Bathroom next to laundry may be designated for staff. Fire extinguisher was serviced and fully charged. Complaint poster posted, resident council info posted, residents' rights posted; emergency disaster plan posted.

Component III was completed by Licensee. Exit interview was conducted. Pre-licensing requirements were met. An exit interview was conducted with Licensee. Report signed on-site by Licensee; printed copy will provided be provided via email due to technical difficulties.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
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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