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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202532
Report Date: 03/07/2025
Date Signed: 03/07/2025 02:17:20 PM

Document Has Been Signed on 03/07/2025 02:17 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:KERN TRANSITION HOME-RIVER GLENFACILITY NUMBER:
157202532
ADMINISTRATOR/
DIRECTOR:		FRAZIER, BRANDYFACILITY TYPE:
735
ADDRESS:4409 RIVER GLEN DRIVETELEPHONE:
(661) 213-3800
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 4DATE:
03/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Direct Service Provider, Jose GarzaTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
NARRATIVE
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On 3/7/2025 Licensing Program Analysts (LPAs) L. Salazar and M. Garza arrived unannounced for an annual inspection visit. LPAs were met by Direct Service Provider (DSP), Jose Garza, explained reason for visit and was permitted entry into the facility. Area Director, Donte Williams was contacted and arrived some time later. Residents at program during time of visit per DSP.

LPAs completed toured the facility inside and out. Pathways and doors inside facility were clear and free from obstruction. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 1/21/25. Last fire drill on 3/3/25. Water temperature measured at 111.5 degrees F in restroom #1. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies kept in resident closets. Sharps and medications were located in locked cabinet. LPAs observed sufficient seating under covered patio area.

The following issues were observed during todays visit: Facility observed to be in need of dusting throughout. Bedroom #3 mattress observed sagging and in need of replacement. Bedroom #3 observed with damage to wall in need of repair and paint. Reclining chair in bedroom #4 observed with broken arm and in need of replacement. Door frame in bedroom bedroom #4 broken and in need of repair. Tile in living room walkway broken and in need of replacement. Couch with odor of urine in living room in need of replacement. Bathroom #2 screen missing and in need of replacement. Debris on side yards in need of removal. Deficiencies and TV's cited per Title 22.

LPAs requested the following documents to be submitted to CCL by 3/21/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) and a copy of surety bond insurance in order to update the facility file.

Exit interview completed with Area Director, Donte Williams. A copy of this report, deficiencies, TV's and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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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Document Has Been Signed on 03/07/2025 02:17 PM - It Cannot Be Edited


Created By: Mary Garza On 03/07/2025 at 01:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KERN TRANSITION HOME-RIVER GLEN
FACILITY NUMBER: 157202532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observations, the licensee did not comply with the section cited above in that Bedroom #2 observed with fan in need of cleaning. Bedroom #3 observed with damage to wall in need of repair and paint. Reclining chair in bedroom #4 observed with broken arm and in need of replacement. Door frame in bedroom bedroom #4 broken and in need of repair. Tile in living room walkway broken and in need of replacement. Couch with odor of urine in living room in need of replacement. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2025
Plan of Correction
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Area Diretor stated they will provide pictures and receipts to CCL as proof of correction by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2025


LIC809 (FAS) - (06/04)
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