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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203951
Report Date: 06/01/2023
Date Signed: 06/01/2023 10:42:37 AM


Document Has Been Signed on 06/01/2023 10:42 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/01/2023 10:42 AM

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

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Amend report

On 06/01/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA arrived and was greeted by caregiver Alwyn Navor. LPA introduced self, stated the purpose of the visit, and was granted entry. The purpose of this visit is to conduct a Plan of Correction (POC) visit to verify that all staff files have the required documents for the deficiency cited on 05/26/23 visit. Administrator Amalia Necer was contacted and arrived shortly.

LPA reviewed staff files and observed to have the required documents.

Deficiency cited on 05/26/23 cleared. POC letter provided to Administrator during visit.

No deficiencies cited during this visit. An exit interview conducted. A copy of this report was provided to Administrator.

SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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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