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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209294
Report Date: 02/09/2023
Date Signed: 02/09/2023 12:14:34 PM


Document Has Been Signed on 02/09/2023 12:14 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:AAA RESIDENTIAL ELDERLY RETREAT #2FACILITY NUMBER:
157209294
ADMINISTRATOR:DILLARD, SHEILAFACILITY TYPE:
740
ADDRESS:1013 WHITE LANETELEPHONE:
(661) 213-6798
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:6CENSUS: 0DATE:
02/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Administrator Sheila DillardTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) K.Kaur conducted a Pre-licensing Inspection on this date. LPA met with Administrator Sheila Dillard. A tour of the facility was conducted together. This is a new facility with no residents in care. The facility was observed to be at a comfortable temperature, clean, and in good repair. No passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. The dining room is equipped with a table and chairs, living room is equipped with adequate sofas and chairs for residents, adequate outside space for rest and recreational under a covered patio.

Perishable and non-perishable food supply appeared adequate. Knives will be locked in the Hallway closet along with medication and first aid kit. Cleaning and Chemical supplies will be kept locked in the garage next to the washing machines. Residents' bedrooms were observed to be adequately furnished with bed, dresser, chair and adequate lighting. Mattresses and linen were in good condition. Extra linen and towels are available. Hot water temperature measured at 105 degrees F. Carbon monoxide and smoke alarm detectors installed and operational. Grab bars installed in showers and by toilets, non-skid mats in place, hand soap and paper towels available for use. Trash cans with tight fitting lids are in place.

Fire extinguisher was serviced and fully charged. Complaint poster posted, resident council info posted, residents' rights posted, emergency disaster plan posted. Gate is self-closing and self-latching. Pool is locked and has signs along the fence for warning.

Component III was also conducted and completed. Exit interview was conducted. Pre-licensing requirements
were met. An exit interview was conducted with Administrator. Report signed on-site by Administrator and
printed copy provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
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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