157209221-8-23-2024-24-AS-MYAG-D8ESW2-20240823141339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157209221
Report Date: 08/23/2024
Date Signed: 08/23/2024 02:13:45 PM

Document Has Been Signed on 08/23/2024 02:13 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:	BECAUSE WE CARE ASSISTED LIVING		FACILITY NUMBER:	157209221
ADMINISTRATOR:	DOBSON, LAURA		FACILITY TYPE:	740
ADDRESS:	4401 BUENA VISTA ROAD		TELEPHONE:	(661) 410-1010
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	6	CENSUS: 6	DATE:	08/23/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Administrator Laura Dobson, RCFE Liasion Collen Alavarez, and Director of Operations Darci Nieton		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/23/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a Required Annual inspection. LPA introduce self, stated the purpose of the visit and requested to meet with Administrator. LPA met with Administrator Laura Dobson, RCFE Liasion Collen Alavarez, and Director of Operations Darci Nieton. All six resident was present during inspection. The facility has 6 single occupancy rooms located in the 300 wing of the Hoffmann Hospice Home. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed. Chemicals are stored in locked housekeeping closet, inaccessible to residents. A supply of extra linen and towels are stored inside front hall closet. Medications were observed in medication cart in locked medication room in the facility. LPA checked medications and reviewed MARs. Facility kitchen is shared with Hoffmann Hospice Home. Food supply was checked and appeared to have an adequate supply in facility pantry, walk in refrigerator, and walk in freezer. Temperature maintained for refrigerator at 40 degrees F and freezer temperature at -2 degrees F. Fire extinguisher was observed throughout facility with a service date of: 09/14/23. Common areas were observed to be spacious with adequate seating. All 6 rooms are fully furnished with adequate lighting according to regulation and are free from odor and debris. Bathrooms were observed with securely fastened grab bars and non-skid flooring. Bathroom hot water temperature was tested at 120 degrees F in room 302, 118.9 degrees F in room 303, 112.5 degrees F in room 304, 113.9 degrees F in room 305, 115.5 degrees F in room 306, and 115.3 degrees F in room 307. Carbon monoxide was observed functional during inspection. LPA observed a hard wired smoke detector system that signals directly to the fire department in case of emergency. Emergency lighting is observed throughout the building and flashlights are charged and readily available.

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BECAUSE WE CARE ASSISTED LIVING	FACILITY NUMBER: 157209221
	VISIT DATE: 08/23/2024

NARRATIVE

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Outside was observed to be free of debris with adequate outside seatings available for residents. Sample of resident and staff files were reviewed.

A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 08/30/23. Forms requested: Lic 308, Lic 500, Lic 610E, and current liability insurance. A copy of this report and appeal rights was provided to Administrator, whose signature on this form confirms receipt of this report.

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/23/2024 02:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BECAUSE WE CARE ASSISTED LIVING	FACILITY NUMBER: 157209221
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/23/2024

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
1 2 3 4	Based on interviews conducted, records review, and observation, staff did not administer R1 and R2’s medications as directed by physician, which poses an immediate health and safety risk for the person in care.
	POC Due Date: 08/24/2024
	Plan of Correction
1 2 3 4	Licensee shall submit documents of steps the facility will take to ensure facility meets the regulation to Fresno CCL office by POC due date 08/24/24. Licensee shall have staff be retrained on administering medications. Licensee will submit documentation of training topics including date, training instructor, and staff attendance rooster to the Fresno CCL office by 09/05/24.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

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