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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206777
Report Date: 02/20/2025
Date Signed: 02/20/2025 11:01:06 AM

Document Has Been Signed on 02/20/2025 11:01 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:DESTINY HOUSEFACILITY NUMBER:
157206777
ADMINISTRATOR/
DIRECTOR:		HARDGE, TAMERRAFACILITY TYPE:
735
ADDRESS:2433 WILLIAMS COURTTELEPHONE:
(661) 279-5053
CITY:ROSAMONDSTATE: CAZIP CODE:
93560
CAPACITY: 4CENSUS: 4DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator Terrence Hardge TIME VISIT/
INSPECTION COMPLETED:
11:05 AM
NARRATIVE
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On 02/20/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct visit for an Annual Inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with staff Yolanda De Avila. Administrator Terrence Hardge was called and arrived shortly during tour. No client was present during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside and outside. An adequate supply of perishable and non-perishable food was observed. Last fire drill completed on 01/26/25. Fire extinguisher was observed with a service date of: 10/23/24.



All clients’ rooms toured and observed to be adequately furnished and lit. Bathrooms were toured and observed operational during inspection. Hot water was tested to be at 119.3 and 120 degrees F and tested to be at 119.2 and 119.6 degrees F in master bathroom. LPA observed medications locked in hall cabinet. MARs were reviewed. Cleaning chemicals were observed stored and locked in hall cabinet. All clients’ and staff files were reviewed to have all the required documents. Outside was toured and observed free of debris. Outdoor seatings available for clients.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6.



Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 02/26/25. The following updated forms were requested: Lic 308, Lic 500, Lic 610D, Lic 9020, and control of property. A copy of this report and appeal rights was provided to Administrator.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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 3
Document Has Been Signed on 02/20/2025 11:01 AM - It Cannot Be Edited


Created By: Mai Yang On 02/20/2025 at 10:49 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: DESTINY HOUSE
FACILITY NUMBER: 157206777

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(b)(5)(B)
80075(b)(5)(B) Once ordered by the physician the medication is given according to the physician's directions.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and observation, the licensee did not comply with the section cited above when LPA and Administrator audit medication. C1’s medication Haloperidol 1 mg had one more tablet in the medication bottle , which poses an immediate health and safety risks to persons in care.
POC Due Date: 02/21/2025
Plan of Correction
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A written plan detailing steps the facility will take to ensure facility meets regulations. Written plan is to be submitted to the Fresno CCL office by due date 02/21/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/20/2025 11:01 AM - It Cannot Be Edited


Created By: Mai Yang On 02/20/2025 at 10:50 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: DESTINY HOUSE
FACILITY NUMBER: 157206777

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(k)(7)
80075 (k)(7) The licensee shall ensure the maintenance, for each client, of a record of centrally stored prescription medications which is retained for at least one year and includes the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and interviews conducted, the licensee did not comply with the section cited above when medications were check and it was observed all of C1 and C2’s current medications were not record in the Centrally Stored Medication Record (Lic 622), which poses/posed a potential health and safety risks to persons in care.
POC Due Date: 02/26/2025
Plan of Correction
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Licensee will submit C1 and C2’s medication’s record on Lic 622 to Fresno CCL office by POC due date 02/26/25.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
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