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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208951
Report Date: 05/09/2024
Date Signed: 05/09/2024 11:21:32 AM

Document Has Been Signed on 05/09/2024 11:21 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:BUENA VISTA MANOR ARF INC.FACILITY NUMBER:
157208951
ADMINISTRATOR/
DIRECTOR:
BAGUIO, MIAFACILITY TYPE:
735
ADDRESS:11126 VISTA DEL VALLE DRIVETELEPHONE:
(661) 885-7838
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 6DATE:
05/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Supervisor Walter Rios and Administrator Mia Baguio TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 05/09/24, 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 with Supervisor Walter Rios. All six client was present upon arrival. Three client left to day program during inspection. Administrator Mia Baguio arrived later 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. Medications were checked and observed kept locked in cabinet in the office area. Clients’ MARS was reviewed. Fire extinguisher was observed with a service date of 03/22/24. Fire drill last completed on 04/17/24. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 40 degrees F. All clients' bedrooms toured and observed to be adequately furnished with bed, dresser, and adequate lighting. Bathrooms were properly equipped. Hot water temperature was tested at 109 degrees F and range at 108.9 in the share bathroom and 107.6 in bathroom. Cleaning supplies and chemicals are kept in locked under kitchen sink and hall closet. Outside of facility toured. Side gate was self-closing with free of debris. Outside was observed with adequate outdoor seatings available for clients. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ and sample of staff files were reviewed to have all the required documents.



No deficiency was cited during inspection.

Exit Interview conducted. The requested documents are to be submitted to the department by 05/15/24: current Administrator certificate, Lic 308, Lic 500, Lic 610D, and Lic 9020. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of these report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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