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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209420
Report Date: 05/06/2024
Date Signed: 05/10/2024 09:30:20 AM


Document Has Been Signed on 05/10/2024 09:30 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:JADE CARE HOMESFACILITY NUMBER:
107209420
ADMINISTRATOR:ESTEBAN, SALLYFACILITY TYPE:
740
ADDRESS:8561 N. CALAVERAS STREETTELEPHONE:
(626) 420-5748
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 0DATE:
05/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Licensee, Jerome and Maricris EstebanTIME COMPLETED:
12:56 PM
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On 5/6/24 Licensing Program Analyst (LPA) M. Garza arrived for an announced pre-licensing inspection visit. LPA was met by Licensees, Jerome Esteban and Maricris Esteban. LPA introduced self, reason for visit and was permitted entry into the facility.

Facility is in the process of pre-licensing. Currently there are no residents residing at the facility. Fire clearance was approved for 6 non-ambulatory residents.

Tour of facility inside and out was completed. During the last visit on 4/23/24, the following issues were observed; 2 of 4 bedrooms observed without required lamps, night stands and dressers. Outside walkway observed to have tripping hazard with a 2-4 inch drop to level ground. Master bedroom door has a 2 inch drop that is a potential tripping hazard. 2 of 2 side gates are not self latching and 1 of 2 gates was missing latch. Bathrooms missing non-skid mats. Visiting policy and complaint policy postings missing.

Corrections have been made to all with the exception of non-skid mats missing from bathrooms and visiting/complaint policy postings missing.

Component III completed during this visit. A return visit has been scheduled for 5/8/2024. At this time the facility is not ready to be licensed. Exit interview completed with Licensee, Jerome and Maricris. Due to technical issues a copy of this report will be emailed for signature. A delivered and read receipt serves as confirmation.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024
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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