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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167204056
Report Date: 01/27/2023
Date Signed: 02/14/2023 02:58:03 PM

Document Has Been Signed on 02/14/2023 02:58 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:LEMOORE ADULT DAYFACILITY NUMBER:
167204056
ADMINISTRATOR:WARTSON, BOBBIEFACILITY TYPE:
775
ADDRESS:1075 BLAKE STREETTELEPHONE:
(559) 924-4419
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY: 15CENSUS: 10DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Program Director, Pan ChinTIME COMPLETED:
04:26 PM
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On 1/27/2023 Licensing Program Analyst (LPA) M. Garza arrived at facility unannounced. LPA met with Program Director, Pan Chin and discussed reason for visit. LPA was not COVID pre-screened at time of entry. LPA completed a tour of the facility and completed a Health and Safety check on clients in care. Clients observed in common area.

LPA observed a central entry point with a supply of hand sanitizer and a sign in policy that includes documented routine symptom screening for resident's, staff and visitors.

Required postings of hand washing observed but not coughing/sneezing etiquette and physical distancing. Staff observed with face coverings. Covered trash bins observed in restroom but not thorough out the facility. A supply of PPE observed. Sink well stocked and liquid soap for hand washing and paper towels for hand drying. Fire extinguishers last serviced 10/26/2022.

LPA requested the following updated forms by 1/3/23: LIC 308, LIC 309, LIC 500, LIC 610D, and LIC 9020.

No deficiencies cited during today's inspection. Exit interview completed with Program Director, Pan Chin. A copy of this report was given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
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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