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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209319
Report Date: 07/17/2024
Date Signed: 07/17/2024 07:19:33 PM

Document Has Been Signed on 07/17/2024 07:19 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:CENTER STREET BOARD AND CARE 2FACILITY NUMBER:
157209319
ADMINISTRATOR/
DIRECTOR:		CRUZ, STEVENFACILITY TYPE:
735
ADDRESS:2451 CENTER STTELEPHONE:
(415) 810-0145
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 18CENSUS: 18DATE:
07/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Regional Director Steven CruzTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 7/17/2024, Licensing Program Analysts (LPAs) K. Kaur and S. Doucette arrived unannounced to deliver findings on subsequent complaint visit.

During medication audit and review of residents Physicians reports and based on interviews; residents are complaining they are not able to see the doctor they are only meeting the LVN for all visits. Per interviews the Physician reports are completed by LVN and stamped with Doctors Name. R2 states she only met with doctor once since being admitted to Facility. This will be reviewed and discussed at a later date.

During the investigation and record review LPA(s) discovered the facility was commingling resident funds with facility funds. LPA(s) conducted interviews and were informed the facility had one bank account for both Operation cost of Center Street Board and Care 2 and resident funds.

Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

An exit interview was conducted with staff. Report signed on-site by staff and copy provided with appeal rights via email.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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 07/17/2024 07:19 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 07/17/2024 at 10:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CENTER STREET BOARD AND CARE 2
FACILITY NUMBER: 157209319

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
CCR
80026(e)

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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents (e) Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash.

This requirement is not met as evidenced by:
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Licensee to separate resident funds and facility funds and submit documentation to CCLD by due date
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Based on record review and interviews Facility is commingling resident’s Social Security funds and facility operation costs.
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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 Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024


LIC809 (FAS) - (06/04)
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