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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167208806
Report Date: 12/05/2022
Date Signed: 12/05/2022 03:37:16 PM

Document Has Been Signed on 12/05/2022 03:37 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:CHESTER CARE HOME 2FACILITY NUMBER:
167208806
ADMINISTRATOR:CHESTER, FLORAYFACILITY TYPE:
735
ADDRESS:1558 PEACHWOOD STREETTELEPHONE:
(559) 362-5674
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY: 6CENSUS: 5DATE:
12/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:14 PM
MET WITH:Administrator, Floray ChesterTIME COMPLETED:
03:45 PM
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On 12/5/2022 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete a case management visit and return files. LPA met with Administrator, Floray Chester and was permitted entry to facility. LPA was COVID pre-screened at entry. LPA completed a Health and Safety check on residents in care. Residents observed in common areas and in rooms.

LPA returned files that were removed from the facility to make copies for the open complaint. LPA informed Administrator that a Investigator would be making contact and completing the complaint investigation.

No deficiencies cited during todays visit.

An exit interview was completed with Administrator, Floray Chester. A copy of this report was given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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