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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203993
Report Date: 07/22/2024
Date Signed: 07/29/2024 08:48:47 AM

Document Has Been Signed on 07/29/2024 08:48 AM - 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/
DIRECTOR:		HARDGE, A. TERRENCEFACILITY TYPE:
735
ADDRESS:3833 SCHERER DRIVETELEPHONE:
(661) 256-4413
CITY:ROSAMONDSTATE: CAZIP CODE:
93560
CAPACITY: 6CENSUS: 4DATE:
07/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:54 AM
MET WITH:Administrator Terrence Hardge TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On 07/22/24, Licensing Program Analyst (LPA) M. Yang conducted case management-deficiency visit to the facility. LPA introduce self, stated the purpose of the visit, and met with Administrator Terrance Hardge.

The purpose of the visit is to address the incident reports from case management visit on 07/15/24. The facility conducted internal investigations, conducted interviews with staff and clients and confirmed S1 yelled at C1 and S2 requested multiple times for C2 physically touched S2. The facility internal investigations confirmed incidents did occurred resulting S1 and S2 terminated immediately after internal investigations. As a result, a deficiency is being cited for the record, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D.

An exit interview was conducted. A copy of this report and appeal rights was provided to Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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 07/29/2024 08:48 AM - It Cannot Be Edited


Created By: Mai Yang On 07/22/2024 at 10:54 AM
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: ROSAMOND RESIDENTIAL HOME AT SCHERER DRIVE
FACILITY NUMBER: 157203993

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2024
Section Cited
CCR
80072(a)(1)

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To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by:
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The facility conduct internal investigation and S1 was terminated on 03/21/24. S2 was terminated on 05/10/24. POC cleared.

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Based on interviews conducted, an internal investigation was completed by Administrator and confirmed that S1 had yelled at C1 and S2 had requesting multiple times for C2 physically touched S2 which poses an immediately health and safety risk for the person in care.
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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:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024


LIC809 (FAS) - (06/04)
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