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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209377
Report Date: 11/13/2024
Date Signed: 11/13/2024 09:50:14 AM

Document Has Been Signed on 11/13/2024 09:50 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:BURLINGTON, THEFACILITY NUMBER:
157209377
ADMINISTRATOR/
DIRECTOR:		BELL, ASHLEYFACILITY TYPE:
740
ADDRESS:13 SYCAMORE DRTELEPHONE:
(760) 376-1365
CITY:WOFFORD HEIGHTSSTATE: CAZIP CODE:
93285
CAPACITY: 22CENSUS: 13DATE:
11/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee Anthony Barbato via telephone, Administrator Ashley Bell via telephone, staff Dolores Garcia, Facility Manager Stacey SmithTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 11/13/24, Licensing Program Analysts (LPA) M. Yang arrived unannounced for a case management - other inspection regarding immediate exclusion of Staff 1 (S1). LPA was greeted by staff Dolores Garcia and met with Facility Manager Stacey Smith. LPA introduce self, stated the purpose of the visit and requested to meet with Administrator. Administrator Ashley Bell and Licensee Anthony Barbato was called. Administrator authorized staff to sign report.


LPA discuss S1 with Administrator and Licensee via telephone.

LPA was informed by Licensee and Administrator that excluded Staff member has been disassociated from the facility and have not been employed for over a year.

No deficiency was observed.

Exit Interview was conducted. A copy of this report was provided via email to Administrator's report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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