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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 160403663
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:28:23 AM

Document Has Been Signed on 05/04/2023 11:28 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:KINGS REHABILITATION CENTER, INC.FACILITY NUMBER:
160403663
ADMINISTRATOR:ACOSTA, SUSANFACILITY TYPE:
775
ADDRESS:490 E. HANFORD ARMONA ROADTELEPHONE:
(559) 582-9234
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 100CENSUS: 19DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Stephanie Sanchez, Program ManagerTIME COMPLETED:
11:35 AM
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On 05/04/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA met Stephanie Sanchez, Program Manager (PM). 15 clients were present during the inspection. LPA completed a tour of the facility with PM.

LPA toured client activity rooms, kitchen area and client restrooms. All classrooms and activity areas were clean and odor free. All passageways and exits were clear and free from obstruction. LPA observed PPE supplies. Visitor log-in was observed upon entry. Fire extinguisher observed serviced date: 3/20/23. Last fire drill completed on 05/3/23. The facility is equipped with fire sprinklers and a fire pull alarm system. First-aid kit was observed in activity room. This day program provides lunch for clients. Food for lunch is brought in daily. Restrooms observed to have an adequate supply of toilet paper, paper towels and soap.

A sample of clients’ file reviewed to have update Emergency contacts, Admission agreement, and IPP. A sample of staffs’ files were also reviewed to have current First Aid/CPR, fingerprinted clear and associated to the facility.

No deficiency observed.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 5/10/23. The following updated forms were requested: current Administrator Certificate, Lic 308, Lic 500, Lic 610D, Lic 9282, and Lic 9020. A copy of this report was provided to Program Manager.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
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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