<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167206688
Report Date: 04/12/2023
Date Signed: 04/12/2023 10:55:39 AM

Document Has Been Signed on 04/12/2023 10:55 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.-DTACFACILITY NUMBER:
167206688
ADMINISTRATOR:ACOSTA, SUSANFACILITY TYPE:
775
ADDRESS:488 E. HANFORD ARMONA RDTELEPHONE:
(559) 583-5051
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 120CENSUS: 83DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Stephanie Sanchez,Program ManagerTIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/12/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA met Stephanie Sanchez, Program Manager (PM). 59 clients were present during the inspection. LPA completed a tour of the facility with PM.

LPA toured the facility inside and outside. All classrooms and activity areas were clean and odor free. The Day Program has 10 classrooms. All passageways and exits were clear and free from obstruction. Visitor log-in was observed upon entry. Hand sanitizer was readily available to clients and visitors. Fire extinguisher observed serviced date 03/20/23. Last fire drill completed on 03/06/23. LPA observed PPE supplies.

Clients bathrooms were observed clean and fixtures were functioning properly. Cleaning supplies observed stored and locked in supply closet. Facility dining area and kitchen toured and appeared clean. Food were observed to be stored in refrigerator and freezer.

LPA observed client’s MARs and locked medications in front office. 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. LPA conducted interviews.

No deficiency observed.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 4/18/23. 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: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1