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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202507
Report Date: 09/01/2023
Date Signed: 09/01/2023 02:31:39 PM


Document Has Been Signed on 09/01/2023 02:31 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:BALANCE RESIDENTIAL CARE CORPORATIONFACILITY NUMBER:
157202507
ADMINISTRATOR:BICERA, VICTORIAFACILITY TYPE:
740
ADDRESS:9802 VERTRICE AVE.TELEPHONE:
(661) 665-0535
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 5DATE:
09/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Linda Natividad, designated representativeTIME COMPLETED:
01:00 PM
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On 09/01/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with Linda Natividad, designated representative (designee). Administrator Victoria “Vicki” Bicera was called and stated unable to attending meeting. All five residents were present during the inspection.

The tour started in the kitchen into the common areas to the resident's rooms. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Fire extinguisher was observed with a service date of: 04/29/23. Cleaning chemicals was observed stored and locked in the garage. Medications were checked and observed kept locked in kitchen cabinet. Residents’ MARS was reviewed. An adequate supply of perishable and non-perishable food was observed. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars and non-skid mat. Hot water temperature was tested 107.6 degrees F. in bathroom 1 and range between 110.3 and 109.6 degrees F. in master bathroom. Carbon monoxide and smoke detectors were tested and observed to be operational.
Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents and free of debris. All residents’ file reviewed to have update Emergency contacts, Admission agreement, Pre-Appraisal form, and physician report. A sample of staff files were also reviewed to have current First Aid/CPR, Personnel Record, Criminal record Statement, and Health Screening. Staff were fingerprinted cleared and associated with facility.

No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 09/07/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, Lic 9282, and control of property. LPA received copy of current Administrator certificate, update facility sketch, and current liability insurance. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of these report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2023
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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