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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209433
Report Date: 09/03/2024
Date Signed: 09/16/2024 10:59:29 AM

Document Has Been Signed on 09/16/2024 10:59 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:ALEXANDER ADULT RESIDENTIAL CAREFACILITY NUMBER:
107209433
ADMINISTRATOR/
DIRECTOR:		ALEXANDER, NICOLEFACILITY TYPE:
735
ADDRESS:381 S THIRD STTELEPHONE:
(559) 381-0994
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY: 6CENSUS: 4DATE:
09/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Nicole Alexander, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:20 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 09/03/24, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing and Component III inspection for Change of Ownership LPA arrived entered to the facility met Licensee/ Administrator Nicole Alexander. No clients present during inspection.

The facility is 6 bedroom and 3 bathroom home which 1 upstairs room and one down stair rooms is designated for staff live in. Fire clearance was granted for 6 Ambulatory for total of 6 capacity. LPA toured the facility with Licensee. Common areas were furnished and had adequate lighting and seats in a comfortable temperature. A fire extinguisher was observed with purchased date of 10/10/23. Kitchen was toured and observed to have dishes, plate, and utensils. Refrigerator temperature maintained at 29 degrees F and freezer temperature at -4 degree F. LPA observed a 2-day supply of perishable foods and a 7 day supply of non-perishable foods. Cleaning supplies and chemicals were observed to be in a locked in laundry cabinet. LPA observed an extra supply of bed linens and personal hygiene products. Medications were kept locked and inaccessible to clients in the hall closet. Bedrooms were observed to have required furnishings. All bathrooms are observed operational during visit. Hot water measured at 109.8 degrees F in bathroom 1 and 112.6 degrees F in the bathroom 2. Outside of facility toured. LPA observed side gates to be self-closing with self-lock. Adequate outdoor seatings observed available for clients. First aid kit was observed and contained all required items. Smoke detectors and carbon monoxide detectors were observed to be operational during this inspection. All client files were reviewed to have Admission Agreements, Physician Reports, ID and Emergency Information and Pre-Appraisal.

Component III was conducted during today's pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB
in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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