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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209175
Report Date: 09/05/2023
Date Signed: 09/05/2023 12:33:30 PM

Document Has Been Signed on 09/05/2023 12:33 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:HERITAGE LIVING IIIFACILITY NUMBER:
157209175
ADMINISTRATOR:GREWAL, SHARNPREETFACILITY TYPE:
735
ADDRESS:3900 DOS LAGOS DRIVETELEPHONE:
(661) 979-0417
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 5DATE:
09/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator Sharnpreet Grewal, Administrator Lorena “Lori” Malhi TIME COMPLETED:
12:30 PM
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On 09/05/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA met with staff Harvinder Kaur. LPA introduce self, stated the purpose of the visit and request to meet with Administrator. Licensee Tina Malhi, Administrator 1 (A1) Sharnpreet Grewal, Administrator (A2) Lorena “Lori” Malhi was called and arrived shortly. All five clients were present upon LPA arrival. Two clients left to day program during inspection. LPA toured facility with A1 and A2.

The tour started in the kitchen into the common areas, to the client’s bedrooms, and bathrooms. The facility was observed to be at a comfortable temperature of 78 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and
non-perishable food was observed. Temperature maintained for refrigerator at 33.1 degrees F and freezer at -1 degrees F. Medications observed kept locked in kitchen shelf. MARs were reviewed. Fire extinguisher was observed with a service date of: 07/07/23. Fire drill last completed: 06/11/23. Cleaning supplies and chemicals stored and locked under kitchen sink and in hall closet. All bedrooms were observed to have required furnishings and with adequate lightening. Bathrooms were properly equipped, and the hot water temperature was tested at 105.2 degrees in bathroom 1 and 105.2 degrees F in bathroom 2. First Aid kit observed with all required documents. Outside of facility toured and observed to be free of debris. Adequate outside seatings observed available for clients. Side gate observed self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have update emergency contacts, Admission agreement, and Pre-Appraisal. All staffs’ files were also reviewed. All staff files were observed to have current First Aid/CPR, fingerprinted clear and associated to the facility.

No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 09/11/23. Forms requested: Lic 308, Lic 500, Lic 610D, Lic 9282, updated facility sketch, and current Administrator certificate. A copy of this report was provided to Administrator 1, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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