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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209320
Report Date: 07/17/2024
Date Signed: 08/05/2024 02:18:04 PM

Document Has Been Signed on 08/05/2024 02:18 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 CAREFACILITY NUMBER:
157209320
ADMINISTRATOR/
DIRECTOR:		STEVEN, CRUZFACILITY TYPE:
735
ADDRESS:2431 CENTER STTELEPHONE:
(415) 810-0145
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 22CENSUS: 22DATE:
07/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:06 AM
MET WITH:Regional Director Steven CruzTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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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 the investigation and record review LPA(s) discovered the facility was commingling resident funds with facility funds and funds of a facility under a different license. LPA(s) conducted interviews and were informed the facility had one bank account for both Operation cost of Center Street Board and Care 2 157209319 and Center Street Board and Care 157209320 and all residents from both facilities. 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 08/05/2024 02:18 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 07/17/2024 at 11:16 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
FACILITY NUMBER: 157209320

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(g)

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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents (g) The licensee shall not commingle cash resources and valuables of clients with those of another community care facility of a different license number regardless of joint ownership.

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 with another licensed facility.
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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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