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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167206283
Report Date: 08/22/2023
Date Signed: 08/22/2023 02:39:09 PM

Document Has Been Signed on 08/22/2023 02:39 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:EMPLOY AMERICA #3FACILITY NUMBER:
167206283
ADMINISTRATOR:REYNOSO, DAWNFACILITY TYPE:
775
ADDRESS:307 MALL DRIVE STE 105TELEPHONE:
(559) 583-0545
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 60CENSUS: 56DATE:
08/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Nicholas Donaldson, Case ManagerTIME COMPLETED:
02:45 PM
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On 8/12/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduce self, stated the purpose of the visit, and met with Case Manager (CM) Nicholas Donaldson. Administrator Dawn Reynoso was called and unavailable to attend meeting. 19 clients were present during the inspection. LPA conducted facility tour with CM.

LPA toured the facility. All passageways and exits were clear and free from obstruction. Facility was at comfortable temperature maintained at 72 degrees F. The Day Program has 7 classrooms. LPA toured lab room, library, art room, media room, computer club, game room and kitchen. All classrooms and activity areas were clean and odor free. Lunches are provided as needed. Clients bring their lunches. Kitchen is for small cooking experiences and appeared clean. No kitchen stove in facility. Food was observed to be stored in refrigerator and freezer. Client’s bathrooms were observed clean, and fixtures were functioning properly. Hot water were tested at 112.9 degrees F in the men bathroom and 113.7 degrees F in the women bathroom. Client locked lockers were observed in the art room and hall. Cleaning supplies observed stored and locked in supply closet. Facility quiet room and changing room was toured. Fire extinguisher observed throughout the facility with a serviced date 09/12/22. Carbon monoxide was tested and observed to be operational.

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 deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by:
8/28/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610D, Lic 9283, and Lic 9020.A copy of this report was provided to Case Manager, whose signature confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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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