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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203993
Report Date: 08/24/2023
Date Signed: 08/24/2023 12:26:58 PM

Document Has Been Signed on 08/24/2023 12:26 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:
08/24/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Administrator Terrance HardgeTIME COMPLETED:
12:30 PM
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On 08/24/23, Licensing Program Analyst (LPA) M. Yang arrived at the facility unannounced to conduct a continuation of the Required Annual Inspection. LPA met with Administrator Terrance Hardge and stated the purpose of the visit.

A sample staff files were also reviewed. Staff files were observed to have current First Aid/CPR, Personal Record, and TB results. Staff are associated with facility.

No deficiencies issued during this inspection.

An exit interview was conducted. 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: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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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