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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200310
Report Date: 04/04/2024
Date Signed: 04/04/2024 10:51:17 AM

Document Has Been Signed on 04/04/2024 10:51 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:LAKE ISABELLA RESPITE CENTERFACILITY NUMBER:
157200310
ADMINISTRATOR/
DIRECTOR:
MCANALLY, KIMBERLYFACILITY TYPE:
775
ADDRESS:6405 LAKE ISABELLA BOULEVARDTELEPHONE:
(661) 665-8871
CITY:LAKE ISABELLASTATE: CAZIP CODE:
93240
CAPACITY: 20CENSUS: DATE:
04/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:Administrator Otilia Benavidez and Manager Jose SosaTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On 04/04/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduce self, state the purpose of the visit and met with Administrator Otilia Benavidez and Manager Jose Sosa. No client were present during the inspection. LPA completed a tour program area with Administrator and Manager.

Area used by day program was observed to be clean & in good repair. Sufficient seating & lighting available. Facility was observed with a sufficient supply of a variety of activity supplies on site and locked in cabinet. Hazardous items and PPE supplies are maintained in locked cabinets. Fire extinguishers observed with serviced date 07/11/23. Meals are provided through the community center kitchen which serves meals to all client in attendance at the center, including participants in this day program. Meals are dropped off to client when client is unable to attend program. Water in restroom sink is on an automated no-touch system and observed bathroom function properly. Client in current attendance do not require any assistance with any medications. All client and staff records reviewed to have all the required documents.



NOTE: This day program is conducted in a room contained within a community center. This day program currently operates at this location only on the 1st Thursdays of the month from 9am to 2:30pm.

No deficiencies cited during today's inspection.

Exit Interview conducted. LPA receive a copy of Lic 308, Lic 610D, Lic 500, Lic 9020, and control of property. A copy of this report was provided to the Administrator, whose signature on this form confirms receipt of this report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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