157206256-4-26-2025-24-AS-MGAA-DG4VAB-20250426161540

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157206256
Report Date: 04/26/2025
Date Signed: 04/26/2025 04:15:56 PM

Document Has Been Signed on 04/26/2025 04:15 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:	LIBERTY IN THE WEST		FACILITY NUMBER:	157206256
ADMINISTRATOR/ DIRECTOR:	ERIC CORONADO		FACILITY TYPE:	735
ADDRESS:	15913 SAN MARCO PL		TELEPHONE:	(661) 332-2949
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93314
CAPACITY: 4		CENSUS: 4	DATE:	04/26/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:26 AM
MET WITH:	House Manager, Carmen Martinez		TIME VISIT/ INSPECTION COMPLETED:	04:24 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/26/25 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived unannounced for an annual inspection visit. LPA was met by House Manager, Carmen Martinez. LPAs introduced selves, explained reason for visit and were permitted entry into the facility. LPAs completed a health and safety check on residents in care. LPAs toured the facility inside and out. Residents observed in common areas and in rooms. There were 4 residents present at the time of the visit. Pathways and doors were clear and free from obstruction. Facility was clean and without odor. 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 11/06/24. Last fire drill on 4/16/25. Water temperature measured 105 degrees. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. Sharps, chemicals and medications were located in locked cabinets and laundry room. LPA observed sufficient seating under covered patio areas. The following issues were observed during todays visit: Stains on living/dining room carpet in need of cleaning. Paint throughout the facility in need of touch up/repainting. Doorway trims throughout the facility broken in need of repair. Light switches throughout the facility in need of tightening/replacement. Cabinets off garage, in bathrooms and in kitchen in need of touch up paint. Concrete flooring in bedrooms/bathrooms and laundry observed with peeling paint in need of repair. Bedroom#3 observed with holes in the wall by bed in need of patching and baseboard broken and in need of repair. Mirror in CONT...

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mary Garza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: LIBERTY IN THE WEST	FACILITY NUMBER: 157206256
	VISIT DATE: 04/26/2025

NARRATIVE

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CONT...

living room in need of repair/replacement. Stucco outside facility observed dirty in need of cleaning, missing/broken and in need of repair. Bathroom#2 observed with mildew on tub grout in need of cleaning. Bathroom#2 has baseboards in need of replacement, blind hardware rusted in need of replacement, door paint near knob bubbling, towel bar bent in need of replacement, light fixture rusted in need of replacement, vent in need of cleaning, paint peeling near sink in need of repair. Blinds in bedroom#4 and living room broken and in need of repair. Storage in garage in need of cleaning. Light in garage in need of cleaning. Backdoor trim/doorway flooring trim broken and in need of repair. Fireplace cover missing and need of replacement. 1 of 4 residents observed as non-ambulatory on their physicians report dated 04/23/24. Facility sketch does not have assembly points identified. Deficiencies cited per Title 22 on 809D.

LPA requested the following documents to be submitted to CCL by 05/02/2025: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Exit interview completed with House Manager, Carmen. A copy of this report, deficiencies, TV's, TA's and appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mary Garza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 05/07/2025 11:20 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/07/2025 11:18 AM

Created By: Mary Garza On 04/26/2025 at 03:20 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: LIBERTY IN THE WEST	FACILITY NUMBER: 157206256
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80010(b)(1)

Limitations on Capacity and Ambulatory Status

(b) Facilities or rooms approved for ambulatory clients only shall not be used by nonambulatory clients. (1) Clients whose condition becomes nonambulatory shall not use rooms or areas restricted to ambulatory clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs record review, the licensee did not comply with the section cited above in 1 of 4 residents observed as non-ambulatory on their physicians report dated 04/23/24. Facility is licensed for ambulatory only. This poses an immediate health, safety or personal rights risk to persons in care. ****Based on additional records reviewed. The Department located the fire clearance that was not present at the facility. Deficiency is dismissed. *****
	POC Due Date: 04/27/2025
	Plan of Correction
1 2 3 4	Administrator stated they will provide a POC in writting stating what correction will be. Adminsitrator stated they will submit new fire clearance forms to CCL for a new fire clearance to be completed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	See Moua
NAME OF LICENSING PROGRAM MANAGER:

	Mary Garza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/26/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 04/26/2025 04:15 PM - It Cannot Be Edited

Created By: Mary Garza On 04/26/2025 at 03:20 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: LIBERTY IN THE WEST	FACILITY NUMBER: 157206256
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2025

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
1 2 3 4	Based on LPAs observation, the licensee did not comply with the section cited above in that Stains on living/dining room carpet in need of cleaning. Paint throughout the facility in need of touch up/repainting. Doorway trims throughout the facility broken in need of repair. Light switches throughout the facility in need of tighting/replacement. Cabinets off garage, in bathrooms and in kitchen in need of touch up paint. Concrete flooring in bedrooms/bathrooms and laudry observed with peeling paint in need of repair. Bedroom#3 observed with holes in the wall by bed in need of patching and baseboard broken and in need of repair. Mirror in living room in need of repair/replacement. Stucco outside facility observed dirty in need of cleaning, missing/broken and in need of repair. Bathroom#2 observed with mildew on tub grout in need of cleaning. Bathroom#2 has baseboards in need of replacement, blind hardware rusted in need of replacement, door paint near knob bubbling, towel bar bent in need of replacement, light fixture rusted in need of replacement, vent in need of cleaning, paint peeling near sink in need of repair. Blinds in bedroom#4 and living room broken and in need of repair. Storage in garage in need of cleaning. Light in garage in need of cleaning. Backdoor trim/doorway flooring trim broken and in need of repair. Fireplace cover missing and need of replacement. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2025
	Plan of Correction
1 2 3 4	Admnistrator stated they will contact maintence and they will be coming to fix repairs needed. Administrator stated they will provide a plan of correction and as items are completed they will provide pictures as proof of correction.

Type B

Section Cited

HSC

1565(a)(1)

Other Provisions

(a) A facility shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (1) Evacuation procedures, including identification of an assembly point or points that shall be included in the facility sketch. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation, the licensee did not comply with the section cited above in that the facility sketch does not have assembly points identified. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2025
	Plan of Correction
1 2 3 4	Administrator stated they will review faciltiy sketch with supervisor and update sketch as needed. Administrator stated they will submit to CCL by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	See Moua
NAME OF LICENSING PROGRAM MANAGER:

	Mary Garza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/26/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC809 (FAS) - (06/04)

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