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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209501
Report Date: 09/18/2024
Date Signed: 09/18/2024 03:00:46 PM

Document Has Been Signed on 09/18/2024 03:00 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:ZEN HOUSE OF CAREFACILITY NUMBER:
107209501
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, NORA P.FACILITY TYPE:
740
ADDRESS:7251 E. HARVARD AVETELEPHONE:
(559) 577-2632
CITY:FRESNOSTATE: CAZIP CODE:
93737
CAPACITY: 6CENSUS: DATE:
09/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:37 AM
MET WITH:Licensee, Nora SanchezTIME VISIT/
INSPECTION COMPLETED:
12:38 PM
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On 09/18/24 Licensing Program Analyst (LPA) M. Garza arrived for an announced pre-licensing inspection visit. LPA was met by Licensees, Nora Sanchez and Administrator, Divina "Grace" Petil. LPA introduced self, reason for visit and were 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.

During visit on 9/11/24 facility was not ready to be licensed and corrections were needed. Todays visit is being conducted to clear issues previous observed.

1) Facility has ramp driveway for accessibility. Yard and stair lights have been added. Reflectors added at stairs for visually impaired residents.
2) All postings have been posted per regulations.
3) Grab bar was installed and sturdy.
4) Facility provided an electronic device (iPad) for resident use.
5) First aid kit is now complete with thermometer.
6) Gaps were filled in with mulch and rock. Gaps no longer observed.
7) Side gate had spring installed to make self latching.
8) Patio observed with umbrella covering seating area.
9) Debris has been removed and no longer observed in back yard.
10) Tools removed from facility and no longer observed.
11) Plan of Operations and Disaster Plan has completed.
12) Documentation added to the admission agreement.

At this time the facility is ready to be licensed. LPA will inform Sacramento. Comp III completed with Licensee and Administrator. Exit interview completed with Licensee and Administrator. A copy of this report was provide.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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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