157208254-10-9-2025-24-AS-MYAG-DMATLM-20251009144946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157208254
Report Date: 10/09/2025
Date Signed: 10/09/2025 02:49:53 PM

Document Has Been Signed on 10/09/2025 02:49 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:	ADAKC		FACILITY NUMBER:	157208254
ADMINISTRATOR/ DIRECTOR:	JUAREZ-CEJA, JULIE		FACILITY TYPE:	775
ADDRESS:	4203 BUENA VISTA RD		TELEPHONE:	(661) 665-8871
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY: 100		CENSUS: 71	DATE:	10/09/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:35 PM
MET WITH:	Administrator Julie Juarez and Executive Director Tamara “Tammy” Baker and Director of Family Servies and Program, Otilia Benavidez		TIME VISIT/ INSPECTION COMPLETED:	02:50 PM

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On 11/25/24, 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) Julie Juarez and Executive Director (ED) Tamara “Tammy” Baker and Director of Family Servies and Program (FSP), Otilia Benavidez. 17 clients were present during inspection. Clients were observed outside in the patio area with staff.

LPA conducted tour with A1, ED, and FSP. Facility is maintained at a comfortable temperature and no passageway obstructions or fire hazards were observed outside and inside. Fire extinguishers throughout the facility was observed with served date: 09/04/25. LPA observed locked medications in medication room. MARs were reviewed and medication was checked. Client's cubbies were observed in the activity room and near bathrooms. Client restrooms were tour, observed to be clean, and operational. Hot water temperature was ranged between 118.9, 116.7, and 115.3 degrees in bathrooms near activity room and 105 and 107.6 degrees in hall bathrooms. Carbon monoxide was tested operational during visit. Day program prepares meals and snacks for clients in the kitchen. Adequate non-perishable and perishable food were observed. Refrigerator temperature was maintained at 40 degrees F and freezer temperature was maintained at -4 degrees. Outside of facility was toured. A gardening tool was observed unlocked by kitchen backdoor. Adequate outdoor seats are available for clients. Chemicals and cleaning supplies were observed locked in storage room. A sample of client and staff files were also reviewed to have the required documents.

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

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 10/15/25. The following updated forms were requested: Lic 308, Lic 500, and Lic 610D. A copy of this report and appeal rights was provided to Administrator, whose signature confirms receipt of this report.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 10/09/2025 02:49 PM - It Cannot Be Edited

Created By: Mai Yang On 10/09/2025 at 02:28 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: ADAKC	FACILITY NUMBER: 157208254
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)

80087 (g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, a shovel was observed unlock on by the kitchen back door on the side of the facility, which poses an immediate health and safety risk to the residents.
	POC Due Date: 10/10/2025
	Plan of Correction
1 2 3 4	Administrator immediately removed and locked shovel in storage room.

Type A

Section Cited

CCR

82075(f)

82075 (f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Staff files were reviewed and interviews conducted, S1 do not have current First Aid/ CPR certification, this poses an immediately health and safety risk for the residents in care.
	POC Due Date: 10/10/2025
	Plan of Correction
1 2 3 4	Administrator stated S1 will complete First Aid and CPR. Proof of S1’s First Aid/ CPR certification is to be submitted to the Fresno CCL by 10/10/25.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	See Moua
NAME OF LICENSING PROGRAM MANAGER:

	Mai Yang
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

LIC809 (FAS) - (06/04)

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