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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208969
Report Date: 10/09/2023
Date Signed: 10/09/2023 09:35:48 AM

Document Has Been Signed on 10/09/2023 09:35 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:PATTI ROSE HOMEFACILITY NUMBER:
157208969
ADMINISTRATOR:HARDGE, TAMERRA AFACILITY TYPE:
735
ADDRESS:3150 PATTI ROSE AVENUETELEPHONE:
(661) 266-4336
CITY:ROSAMONDSTATE: CAZIP CODE:
93560
CAPACITY: 4CENSUS: 2DATE:
10/09/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Yolanda De Avila, caregiverTIME COMPLETED:
09:45 AM
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On 10/09/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced for a Post Licensing Inspection. LPA met caregiver Yolanda De Avila. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. Administrator Terrence Hardge was called and unable to attend meeting. Administrator authorized caregiver to sign and receive report. LPA toured facility with caregiver. No client was present during tour.

Facility was observed at a comfortable temperature at 70 degrees F, clean, and no passageway obstructions or fire hazards inside. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Kitchen was toured and observed. LPA observed a 2-day supply of perishable and 7-day supply of non-perishable food. Refrigerator temperature was maintained at 40 degrees F and freezer temperature was maintained at -2 degrees F. A fire extinguisher was observed with a purchased date of 08/25/2023. Knives and cleaning supplies were observed kept locked and secure in the dining cabinet. Medications observed on top shelf locked in dining cabinet. MARs were reviewed.

LPA observed an extra supply of bed linens. LPA observed two single occupant bedrooms and two vacant bedrooms. Bedrooms were observed to have required furnishings. Bathrooms were observed to be operational. Hot water tested at degrees F range between 107.2 in bathroom 1 and 107.4 degrees F in vacant master bathroom. Washer was observed operating during inspection.



Outside of facility toured. Outdoor seatings were observed available for clients. Exits were open and free of obstructions. LPA observed side gate to be self-closing. All client’s file reviewed to have updated emergency contact information and Admission agreements on file. Smoke detectors and carbon monoxide detectors were observed to be operational during this inspection.

No deficiencies issued during this inspection.

Exit interview was conducted. A copy of this report was provided to caregiver, whose signature confirms receipt of this report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2023
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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