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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203993
Report Date: 08/10/2023
Date Signed: 08/10/2023 03:17:43 PM

Document Has Been Signed on 08/10/2023 03:17 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:ROSAMOND RESIDENTIAL HOME AT SCHERER DRIVEFACILITY NUMBER:
157203993
ADMINISTRATOR:HARDGE, A. TERRENCEFACILITY TYPE:
735
ADDRESS:3833 SCHERER DRIVETELEPHONE:
(661) 256-4413
CITY:ROSAMONDSTATE: CAZIP CODE:
93560
CAPACITY: 6CENSUS: 4DATE:
08/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Yolanda De Avila, Caregiver TIME COMPLETED:
03:30 PM
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On 08/10/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual inspection. LPA introduced self, stated the purpose of the visit, and was greeted by caregiver Yolanda De Avila. LPA was granted entry into the facility. Administrator Terrance Hardge was called and stated unable to attend meeting. Administrator authorized caregiver to sign and receive report. LPA toured facility with caregiver. Two clients were present during inspection.

The tour started in the kitchen into the common areas, to clients’ bedrooms, and bathrooms. The facility
was observed to be at a comfortable temperature of 76 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Refrigerated temperature maintained at 39 degrees F and freezer temperature maintained at 0 degrees F. Fire drill last completed on 07/24/23. Medications are kept locked in kitchen shelf. MARs were reviewed. Cleaning chemicals observed store and locked inaccessible in the office. LPA toured all client’s bedrooms and observed 4 single occupant rooms. Clients’ room observed to be adequately furnished with bed, dresser, and adequate lighting. Bathrooms were properly equipped, and the hot water temperature was tested 107.1 degrees F in bathroom 1. and range between 104.6 and 106.3 degrees F in the master bathroom. Outside of facility was toured. Side gate was self-closing and self-latching. Outside seatings available for clients. All clients’ file reviewed. Smoke detectors and carbon monoxide were tested and observed to be operational.

LPA will return to review staff records and complete annual inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 8/16/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610D, Lic 9282, update facility sketch, and current Administrator Certificate. A copy of this report was caregiver, whose signature confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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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