<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206735
Report Date: 06/21/2023
Date Signed: 08/01/2023 04:10:47 PM


Document Has Been Signed on 08/01/2023 04:10 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:RIDGECREST HOME CAREFACILITY NUMBER:
157206735
ADMINISTRATOR:ZAMORA, CRISTINAFACILITY TYPE:
740
ADDRESS:1028 KINNETT AVENUETELEPHONE:
(760) 463-1180
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:5CENSUS: 3DATE:
06/21/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Licensee- Cristina ZamoraTIME COMPLETED:
06:45 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 6/21/23 at 11:38 A.M. Licensing Program Analyst (LPA) B. Miranda & S. Doucette arrived at the facility unannounced to conduct a POC visit. LPA’s knocked and rang doorbell. LPAs observed hallway door to the bedrooms to be closed and residents to be in the living room by themselves. Staff member opened the front door later and stated they were in the garage. LPAs asked how many staff members were at the facility, S1 stated there is only one and the other staff member will be right back. Licensee was contacted and arrived shortly after.

LPA's came to the facility regarding POC information not being received.

LPAs observed 2 residents in the facility needing complete and total care without being on hospice. LPAs only observed one staff member at the facility, 2 staff members are needed to operate the Hoyer Lift and to rotate the residents. LPA's received a staff schedule showing only one staff on several shifts. Facility does not have a current administrator and no current CPR card. Licensee/Administrator needs current health screening.

LPAs observed medication cabinet to be unlocked and accessible to residents. MARS and Centrally Stored Medication log was not current/completed. LPAs did not receive death reports in a timely manner. LPAs observed no perishable meat/protein. LPA's took photos of unlocked medication cabinet, MARS log, Centrally stored log, living room door which was closed and food.

Citations were issued for deficiencies at the facility. Civil penalties were issued for failure to correct violations.

Exit interview completed and copies of this report, LIC809Ds, & Civil Penalties were printed and provided to Licensee.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7


Document Has Been Signed on 08/01/2023 04:10 PM - It Cannot Be Edited

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: RIDGECREST HOME CARE
FACILITY NUMBER: 157206735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2023
Section Cited
CCR
87615(a)(5)

1
2
3
4
5
6
7
87615 Prohibited Health Conditions
(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:
(5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities.
1
2
3
4
5
6
7
Submitting a plan to get a high level of care for R1 and R2.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed R1 & R2 to have a prohibited health condition, which requires staff to perform all activities of daily living.
8
9
10
11
12
13
14
Civil Penalties was issued due to POC not being cleared timely.
Type A
06/22/2023
Section Cited
CCR87405(a)

1
2
3
4
5
6
7
87405 Administrator - Qualifications and Duties
(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified
1
2
3
4
5
6
7
Licensee will provide copy of Administrator certificate and copy of Administrator's schedule
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA was informed by Licensee/Administrator the Administrator Certificate has expired.
8
9
10
11
12
13
14
Civil Penalties was issued due to POC not being cleared timely.
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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7


Document Has Been Signed on 08/01/2023 04:10 PM - It Cannot Be Edited

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: RIDGECREST HOME CARE
FACILITY NUMBER: 157206735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2023
Section Cited
CCR
87465(h)(2)

1
2
3
4
5
6
7
(h) The following requirements shall apply to medications which are centrally stored:
(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
1
2
3
4
5
6
7
Licensee will remind staff to keep medication cabinet locked.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed medication cabinet to be unlocked and accessible to residents.
8
9
10
11
12
13
14
Type A
06/22/2023
Section Cited
CCR87465(a)(4)

1
2
3
4
5
6
7
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed.
1
2
3
4
5
6
7
Licensee will be verifying medication is administered and logged properly on MARS daily. Licensee will provide copy of instructions given to staff regarding MARs log.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed medication MARS log not being completed which indicates no medications were given today. This indicates residents were not assisted with self administered medications
8
9
10
11
12
13
14
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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7


Document Has Been Signed on 08/01/2023 04:10 PM - It Cannot Be Edited

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: RIDGECREST HOME CARE
FACILITY NUMBER: 157206735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2023
Section Cited
CCR
87411(a)

1
2
3
4
5
6
7
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
1
2
3
4
5
6
7
Licensee will schedule additional caregiver. New staff schedule will be submitted by 6/30/23
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed 1 staff member at the facility when 2 of the residents require a Hoyer Lift and 1 needs to be rotated.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7


Document Has Been Signed on 08/01/2023 04:10 PM - It Cannot Be Edited

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: RIDGECREST HOME CARE
FACILITY NUMBER: 157206735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
87411(c)(1)

1
2
3
4
5
6
7
(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.
1
2
3
4
5
6
7
Licensee completed CPR training today.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Administrator does not have a current CPR certificate.
8
9
10
11
12
13
14
Type B
06/30/2023
Section Cited
CCR87411(f)

1
2
3
4
5
6
7
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties.
1
2
3
4
5
6
7
Administrator will submit LIC603
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA needs to have current health screening from Licensee/Administrator
8
9
10
11
12
13
14
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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 08/01/2023 04:10 PM - It Cannot Be Edited

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: RIDGECREST HOME CARE
FACILITY NUMBER: 157206735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
87465(a)(6)

1
2
3
4
5
6
7
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.
1
2
3
4
5
6
7
Licensee will come to the facility and verify Centrally stored medication log is complete. Licensee will have meeting and submit verification of meeting.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPAs observed Centrally Stored Medication log to not be complete and maintained.
8
9
10
11
12
13
14
Type B
06/30/2023
Section Cited
CCR87705(c)(5)

1
2
3
4
5
6
7
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:
(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs.
1
2
3
4
5
6
7
Licensee will have updated LIC602 and submit updated forms to LPA.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPAs observed LIC602 in resident's files to not be current. Last LIC602 was from 2021.
8
9
10
11
12
13
14
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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 08/01/2023 04:10 PM - It Cannot Be Edited

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: RIDGECREST HOME CARE
FACILITY NUMBER: 157206735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
87555(a)

1
2
3
4
5
6
7
(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.
1
2
3
4
5
6
7
Licensee will buy fresh protein or get doctors note indicating special diet. Licensee will provide verification
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPAs did not observe perishable meat/protein at the facility.
8
9
10
11
12
13
14
Type B
06/30/2023
Section Cited
CCR87211(a)(1)(A)

1
2
3
4
5
6
7
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:
(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility.
1
2
3
4
5
6
7
Licensee will be submitting reports.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on LPAs observations, interview, and record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Facility had 2 deaths which not reported timely.
8
9
10
11
12
13
14
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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 7 of 7