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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206769
Report Date: 09/18/2023
Date Signed: 09/18/2023 03:21:22 PM

Document Has Been Signed on 09/18/2023 03:21 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:SAILS RANCHOFACILITY NUMBER:
157206769
ADMINISTRATOR:MARQUEZ, BERTAFACILITY TYPE:
735
ADDRESS:4644 WYATT STTELEPHONE:
(760) 547-7626
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 4CENSUS: 4DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Administrator Jose Marquez TIME COMPLETED:
03:45 PM
NARRATIVE
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On 9/18/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by administrator Jose Marquez while administrator Bertha Marquez is on leave.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in the living room was last serviced on 4/10/23 and was fully charged. At 10:38 AM LPA observed one living room window screen and resident room window screen to be bent. All common areas were properly furnished and well-lit throughout. Medications, First Aid, Resident/Staff files, and Sharp items locked in the first hallway closet.

LPA toured 4 resident rooms. All client bedrooms toured and observed to be adequately furnished. LPA toured laundry area which appeared clean. Cleaning supplies and chemicals are locked in the garage closet. At 11:06 AM LPA observed hallway Restroom to have a strong odor although restroom appeared clean. Extra linen and hygiene supply kept in resident’s bedrooms. The exterior tour was conducted. Backyard observed to have sufficient seating under patio. Medication was reviewed. Staff records were reviewed for good health and training. All clients’ records reviewed to have Admission Agreement, Physician’s Report and emergency contact information. Last fire drill completed on 9/4/2023.

Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

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SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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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Document Has Been Signed on 09/18/2023 03:21 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 09/18/2023 at 02:58 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: SAILS RANCHO
FACILITY NUMBER: 157206769

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(b)
Fixtures, Furniture, Equipment, and Supplies
(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 2 window screens to be bent which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2023
Plan of Correction
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Licensee to replace or repair window screens and provide pictures to CCLD by due date
Type B
Section Cited
CCR
80087(a)
80087 (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
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Based on observation, the licensee did not comply with the section cited above in 1 out of 2 restrooms. LPA observed strong odor which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/02/2023
Plan of Correction
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Licensee to ensure bathroom is cleaned and determine where the odor is coming from and make necessary cleaning changes/ repairs to avoid future issues.
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:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023


LIC809 (FAS) - (06/04)
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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: SAILS RANCHO
FACILITY NUMBER: 157206769
VISIT DATE: 09/18/2023
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LPA is requesting the following documents be submitted to the Fresno CCL office by 10/02/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization
(LIC309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan
(LIC610E), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Administrator. Report signed on-site; and a printed copy was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
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