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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208892
Report Date: 10/20/2022
Date Signed: 10/21/2022 01:40:00 PM

Document Has Been Signed on 10/21/2022 01:40 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 VIFACILITY NUMBER:
157208892
ADMINISTRATOR:BARNHARD, RAYMONDFACILITY TYPE:
735
ADDRESS:10117 ST ALBANS AVETELEPHONE:
(661) 473-2340
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 5CENSUS: 5DATE:
10/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Jessica DelgadilloTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct a case management visit to follow up on a report submitted by the facility on 10/19/2022. LPA announced the reason for the visit to S1. AD later arrived about 10 minutes later. LPA obtained the records of S3, R1, and R4. This matter requires further review. LPA will return at a later date for additional follow up if needed. No deficiencies were cited at this time. A copy of this report was provided to AD. LPA observed S1 & S2 on duty, R3 was watching TV, and R1 & R2 were in their rooms. LPA toured the facility; room temperature was at 71 degrees. Facility was observed to have 1 fire extinguisher & last serviced on 3/23/2022. The facility has enough perishable food for 2 days and nonperishable food for 7 days. Staff was washing residents’ blankets and sheets. Medication and knives were locked in closet. Extra PPE was observed. Health and Safety check today included overall safety of the facility including food supply, physical plant residents, and staffing. No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conducted.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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