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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209335
Report Date: 11/21/2023
Date Signed: 11/21/2023 11:27:22 AM

Document Has Been Signed on 11/21/2023 11:27 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:D VILLA ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
157209335
ADMINISTRATOR:NOBLEZA, BASILISAFACILITY TYPE:
735
ADDRESS:1709 D STREETTELEPHONE:
(661) 808-6081
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY: 25CENSUS: 22DATE:
11/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Basilisa and John Nobleza, LicenseesTIME COMPLETED:
11:45 AM
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On 11/21/23 at 9:07 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Pre-licensing inspection. LPA met with Licensees (LIC) Basilisa and John Nobleza.

LPA toured inside and outside of facility. No obstructions observed. All bedrooms observed with sufficient furniture and lighting. Sufficient linen observed. Hot water measured 119.6 degrees F. Carbon monoxide detector tested and operational. Fire alarm pull station installed. Facility set at comfortable temperature. Dishware and utensils observed. Sharps will be kept in a locked tool box container. Centrally stored medication observed in a med cart. First aid kit observed complete. Emergency lighting observed. Chemicals observed locked in cabinet inside staff bathroom. Sufficient food supply observed.

Comp III was completed with Licensees.

Exit interview was conducted. A copy of this report was given to Licensee, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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