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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208254
Report Date: 12/01/2023
Date Signed: 12/01/2023 05:01:11 PM

Document Has Been Signed on 12/01/2023 05:01 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:ADAKCFACILITY NUMBER:
157208254
ADMINISTRATOR:CAPRA, JANELLEFACILITY TYPE:
775
ADDRESS:4203 BUENA VISTA RDTELEPHONE:
(661) 665-8871
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 100CENSUS: 35DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Administrator Janelle Capra, Family Service Director Otilia Benavidez and Director of Programs Julie Juarez-CejaTIME COMPLETED:
12:15 PM
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On 12/01/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met Administrator (A1) Janelle Capra, Family Service Director (FSD) Otilia Benavidez, and Director of Programs (DP) Julie Juarez-Ceja. 18 clients were present during the inspection. LPA completed a tour of the facility with FSD and DP. 15 clients were present during inspection. Clients were observed in the activity room and one client in the café. Transportation is available and provided for clients.

Facility is maintained at a comfortable temperature at 71 degrees F and no passageway obstructions or fire hazards were observed. LPA observed locked medications in locked locker in Program Manager office. MARs were reviewed.

LPA toured and observed water station in the café. Day program prepares 2 meals and snacks for clients in the kitchen. Adequate non-perishable and perishable food were observed. Refrigerator temperature was maintained at 37 degrees F. Client restrooms were tour, observed to be clean, and operational. Hot water temperature was 110.5 degrees in bathroom 1 and 108.4 degrees in bathroom 2. Fire extinguishers throughout the facility was observed with served date: 08/22/23. Last fire drill completed on 07/12/23. Chemicals and cleaning supplies were observed locked in storage room.

A sample of client files were also reviewed to have the required documents. Staff files were reviewed and observed to have all the required documents.

No deficiency observed.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 12/07/23. The following updated forms were requested: Lic 308, Lic 500, and Lic 610D. A copy of this report was provided to the Director of Programs, whose signature confirms receipt of this report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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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