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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208962
Report Date: 05/21/2025
Date Signed: 05/23/2025 11:02:10 AM

Document Has Been Signed on 05/23/2025 11:02 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:ARCADIA GARDENS RESIDENTIAL CARE IVFACILITY NUMBER:
157208962
ADMINISTRATOR/
DIRECTOR:		ROURA, OLIVIAFACILITY TYPE:
740
ADDRESS:12301 RIVERFRONT PARK DRIVETELEPHONE:
(661) 412-7042
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
05/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Olivia Roura, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On 05/21/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a Annual visit. LPA introduced self, stated the purpose of the visit, and was greeted by staff Jimmy Flores. Licensee (L1) Olivia Roura was called and arrived shortly. LPA toured facility with L1 toured facility with staff. All six residents were present 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 or outside. Medications are kept locked in hall closet. LPA audit medications and reviewed MARs. Fire extinguisher was observed with a service date of 04/25/25. Last fire drill completed 04/20/25.An adequate supply of perishable and non-perishable food was observed. Temperature observed refrigerator maintain a 40 degrees F and freezer temperature at -1 degree F. LPA observed cleaning chemicals stored and locked in laundry shelves. LPA toured all resident’s bedrooms. Resident rooms observed to be adequately furnished with bed, dresser, and adequate lighting. Bathrooms were properly equipped, and the hot water temperature was tested at 116.2 degrees F in hall bathroom and 117.3 and 118.1 degrees F shared master bathroom. Outside of facility toured. Side gate was self-closing and self-latching. Adequate outdoor seatings observed available for residents. Carbon monoxide and smoke detectors were tested and observed to be operational. All of resident and sample of staff files were reviewed.

A deficiency is being cited on the attached Lic 809D and an immediate Civil Penalty was assessed. See Lic 421IM is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview conducted. LPA received copy of Lic 500, Lic 9020, current Administrator certificate, The following updated forms were requested to be submitted to Fresno CCL by 05/27/25: Lic 308, Lic 610E, control of property, and current liability insurance. A copy of this report and appeal rights was provided to Licensee.

See MouaTELEPHONE: (559) -65-7912
Mai YangTELEPHONE: 559-772-7402
DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2025
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 05/23/2025 11:02 AM - It Cannot Be Edited


Created By: Mai Yang On 05/21/2025 at 01:27 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: ARCADIA GARDENS RESIDENTIAL CARE IV
FACILITY NUMBER: 157208962

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(c)(2)
87465(c)(2) Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed and observation, the licensee did not comply with the section cited above. LPA audit resident’s medications and reviewed resident’s MARS; observed R1’s medication Quetiapine 25mg not administered as directed by physician which poses an immediate health, safety or personal rights risk to person in care.
POC Due Date: 05/22/2025
Plan of Correction
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S1 will have in-service retraining on medication. Records of training materials and proof attendance will be submitted to Fresno CCL office by POC due date 05/22/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
TELEPHONE: (559) -65-7912
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: 559-772-7402
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/23/2025 11:02 AM - It Cannot Be Edited


Created By: Mai Yang On 05/21/2025 at 01:29 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: ARCADIA GARDENS RESIDENTIAL CARE IV
FACILITY NUMBER: 157208962

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(c)
87412(c) Licensees shall maintain in the personnel records verification of required staff training and orientation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed and interviews, no records of staff trainings on file for S1. All staff does not have required
Hoyer lift training in file, which poses a potential health and safety risk for the person in care.
POC Due Date: 06/03/2025
Plan of Correction
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Facility shall review regulation section 87412 and ensure that all staff have the required training. Proof of S1 trainings and all staff trained on Hoyer lift is to be submitted to the Fresno CCL office by the POC due date 06/03/25.

Proof of training shall include the following: Trainer’s full name and title; Subject(s) covered in the training; Date(s) of attendance; and Number of training hours per subject.
Type B
Section Cited
HSC
1796.45
1796.45 Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and interviews conducted, S1 did not have a TB result, which poses a potential risk to the health and safety of the residents.
POC Due Date: 06/03/2025
Plan of Correction
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Licensee shall ensure all staff have a TB result on file prior or within 7 days after employment. S1 TB result shall be submitted to the Fresno CCL office by POC due date 06/03/25.
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:
TELEPHONE: (559) -65-7912
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: 559-772-7402
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/23/2025 11:02 AM - It Cannot Be Edited


Created By: Mai Yang On 05/21/2025 at 01:35 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: ARCADIA GARDENS RESIDENTIAL CARE IV
FACILITY NUMBER: 157208962

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(5)(B)
87608(a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and records reviewed, R1 and R2 is on hospice care and was observed with full rail bed with no doctor’s order, which poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 05/27/2025
Plan of Correction
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Licensee shall obtain doctor orders for R1 and R2 who’s currently receiving hospice care that specific the need for full bed rails. If R1 and R2 is not eligible for hospice evaluation to retain a full bed rail, seek physician order for half bed rails and remove full bed rails. If no order is obtained full rail shall be removed by POC due date. If Order is obtained, shall be submitted to the Fresno CCL by POC due date 05/27/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
TELEPHONE: (559) -65-7912
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: 559-772-7402
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2025


LIC809 (FAS) - (06/04)
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