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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206726
Report Date: 04/29/2024
Date Signed: 04/29/2024 11:27:32 AM


Document Has Been Signed on 04/29/2024 11:27 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:HERITAGE LIVING IFACILITY NUMBER:
157206726
ADMINISTRATOR:TINA MALHIFACILITY TYPE:
740
ADDRESS:10411 BLYTHE CT.TELEPHONE:
(661) 664-9535
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 6DATE:
04/29/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Administrator Tina Malhi and Assistant Administrator Sharnpreet "Pree" MalhiTIME COMPLETED:
11:30 AM
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On 04/29/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual continuation visit. LPA introduce self, stated the purpose of the visit and requested to meet with the Administrator. LPA met caregiver Emilie Munoz. Licensee/ Administrator Tina Malhi was called and arrived shortly. All six residents were present during inspection.

All residents and sample of staff files were observed with the required documents.

No deficiency cited during this inspection.

Exit Interview conducted. The requested documents are to be submitted to the department by 05/05/24: Lic 308, Lic 500, Lic 610E, current liability insurance, and current Administrator Certificate. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of this report.

SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2024
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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