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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 160400627
Report Date: 05/04/2023
Date Signed: 05/04/2023 02:43:28 PM


Document Has Been Signed on 05/04/2023 02:43 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:VALLEY CHRISTIAN HOMEFACILITY NUMBER:
160400627
ADMINISTRATOR:ALVIDREZ, ERINFACILITY TYPE:
740
ADDRESS:511 E. MALONE ST.TELEPHONE:
(559) 585-3000
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:131CENSUS: 57DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Administrator Erin AlvidrezTIME COMPLETED:
03:00 PM
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On 5/4/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA met with Administrator Erin Alvidrez. LPA introduced self, stated the purpose of the visit. LPA toured facility with Administrator.

LPA toured inside and outside of the facility. Facility has three wings: north, south, west wings, 3 dining areas, and a kitchen. Facility also has a salon, library, and activity's room. The facility was observed to be at a comfortable temperature, odor-free, and in good repair. There were no obstruction or fire clearance related issues. The fire extinguisher was observed throughout the facility with a service date of: 12/21/22. An adequate supply of linens and personal hygiene products were observed.



Bedrooms were observed to have adequate lighting and required furniture and bedding. Bathrooms were properly equipped with non-skid surface/mat, securely fastened grab bars, and trash can with lids. Hot water temperature was tested at 113.5 to 115.1 degrees F. An adequate supply of perishable and non-perishable food was observed. Food was observed to be properly labelled and stored with a sufficient supply. Medications are kept in a locked Med Room. A sample of residents’ MARS was reviewed. Outside was toured and observed free of debris. There are no bodies of water of the premises.

A sample of residents’ file reviewed to have update Emergency contacts, Admission agreement, Pre-Appraisal form, and physician report. A sample of staff's files were also reviewed to have current First Aid/CPR, fingerprinted clear and associated to the facility.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 5/10/23. The following updated forms were requested: Lic 308, Lic 309 (if applicable), Lic 500, Lic 610E, Lic 9282, and current Administrator certificate. A copy of this report was provided to the Administrator.

SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
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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