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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202449
Report Date: 02/21/2024
Date Signed: 02/21/2024 10:28:29 AM

Document Has Been Signed on 02/21/2024 10:28 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:PTS FOURFACILITY NUMBER:
157202449
ADMINISTRATOR:RODRIGUEZ, MARIANAFACILITY TYPE:
735
ADDRESS:9207 BLOSSOM TIME AVENUETELEPHONE:
(661) 496-8188
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 4CENSUS: 4DATE:
02/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Administrator Mariana RodriguezTIME COMPLETED:
10:30 AM
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On 01/08/24 Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual
Inspection. LPA introduced self, stated the purpose of the visit, and was greet by Administrator Mariana Rodriguez. No client was present upon LPA arrival.

LPA toured facility. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -18 degrees F and refrigerator temperature was maintained at 40 degrees F.



Fire extinguisher was observed with a service date of: 01/09/24. Fire drill last completed on 02/01/24. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operating. Hot water temperature was tested 105.2 degrees F. in bathroom 1 and range between 107 degree F and 106.6 degree F. in bathroom master bathroom. Cleaning chemicals was observed stored and locked in the garage cabinet.

Outside of facility toured. Side gate was self-closing with no debris. Outside was observed with adequate outdoor seatings available for clients. Carbon monoxide and smoke detectors were tested and observed to be operational. Medications were checked and observed kept locked in hall closet. Clients’ MARS was reviewed. Medications were checked and observed kept locked in hall closet. All clients’ and staff files reviewed to have all the required documents.

No deficiency cited during inspection.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 02/27/24: Lic 308, Lic 500, Lic 610D, and current Administrator certificate. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of these report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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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