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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209223
Report Date: 05/12/2023
Date Signed: 05/16/2023 11:06:58 AM


Document Has Been Signed on 05/16/2023 11:06 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/16/2023 11:04 AM

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

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Amended report

On 05/16/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA arrived and was greeted by Licensee Yaninee Asawadilokchai. LPA introduced self, stated the purpose of the visit, and was granted entry. LPA conducted tour with Licensee. Licensee stated there are currently no residents and staff at the facility. No residents or staff were present during inspection.

The tour started in the common areas into the kitchen and to the resident's rooms. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards was observed inside. LPA observed COVID-19 related signs. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature maintained at 35 degrees F and freezer temperature at 0-degree F. Medications will be stored in medication closet in facility hallway. LPA observed 3 vacant shared residents’ bed to be at least 6 feet apart. Residents' bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting.



Bathrooms were properly equipped and observed with non-skid mat. Hot water temperature was tested 119.8 degrees F and range from 115.4 to 120 degrees F in shared bathroom. Hand washing postings was observed. Outside of facility toured. Side gate was self-closing and free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 5/22/23. The following updated forms were requested: updated facility sketch, Lic 308, Lic 610E, Lic 9282, and current liability insurance. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of these report.

SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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