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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209299
Report Date: 03/12/2024
Date Signed: 03/12/2024 11:49:32 AM


Document Has Been Signed on 03/12/2024 11:49 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:LERWICK HOME CAREFACILITY NUMBER:
157209299
ADMINISTRATOR:TELMO, SOCORRO ANNFACILITY TYPE:
740
ADDRESS:10213 LERWICK AVENUETELEPHONE:
(661) 665-2874
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 5DATE:
03/12/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensees Socorro Ann Telmo and Dio TelmoTIME COMPLETED:
12:00 PM
NARRATIVE
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On 03/12/24 a Non-Compliance Conference (NCC) was held at Fresno Regional Center Office. Regional Manager (RM) Brenda White, Licensing Program Manager (LPM) See Moua, and Licensing Program Analyst (LPA) Mai Yang met with Licensees Socorro Ann Telmo and Dio Telmo.

The following issues were discussed:
-Complaint received on 01/22/2024
-Deficiency issued on 01/31/24 for complaint
-Deficiency issued for 87405(d)(2) Administrator - Qualifications and Duties - Knowledge of and ability to conform to the applicable laws, rules and regulations.

Licensee agreed to accept Technical Support Program (TSP) services, and the department will begin the process of initiating TSP services.

Exit interview conducted. Report and appeals provided to Licensees during meeting.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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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Document Has Been Signed on 03/12/2024 11:49 AM - 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: LERWICK HOME CARE
FACILITY NUMBER: 157209299

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2024
Section Cited
CCR
87405(d)(2)

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Administrator - Qualifications and Duties - Knowledge of and ability to conform to the applicable laws, rules and regulations.

This requirement is not met as evidenced by:
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POC discussed during NCC.
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Based on interviews conducted, the Administrator admitted to using the resident debt card, withdrawing cash from ATM with resident debit card, and writing checks out from the resident’s check book.
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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 MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
LIC809 (FAS) - (06/04)
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