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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208816
Report Date: 08/02/2023
Date Signed: 08/02/2023 08:58:21 AM


Document Has Been Signed on 08/02/2023 08:58 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:OAK MANOR CARE CENTERFACILITY NUMBER:
157208816
ADMINISTRATOR:BRANCH, BRIANNAFACILITY TYPE:
740
ADDRESS:9604 VALLEY FOREST CTTELEPHONE:
(661) 282-5200
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee Brianna Branch TIME COMPLETED:
09:00 AM
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On 08/02/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a Case
Management visit and met with Licensee Brianna Branch. The purpose of this visit was to conduct a
final walk through. Licensee has surrendered license. No staff and residents present.

LPA toured the facility inside and outside. All bedrooms and bathrooms were empty of personal belongings.
There was no indication of any resident living in the facility.

Forfeiture to be sent. The facility will be closed effective 08/02/23, pending Licensing Program Manager
approval. RO to contact LTCO. Exit interview conducted. A copy of the report was provided to the Licensee.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
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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