207202556-1-26-2023-24-AS-BMIA-CNG846-20230126211033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 207202556
Report Date: 01/26/2023
Date Signed: 01/26/2023 09:12:01 PM

Document Has Been Signed on 01/26/2023 09:12 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:	MCALISTER'S RCFE		FACILITY NUMBER:	207202556
ADMINISTRATOR:	MC ALISTER, DUANE		FACILITY TYPE:	740
ADDRESS:	11976 RD 36 1/2		TELEPHONE:	(559) 645-1861
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY:	6	CENSUS: 4	DATE:	01/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Administrator-Duane McAlister		TIME COMPLETED:	11:15 AM

NARRATIVE

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On 1/26/2023 at 9:05 a.m., Licensing Program Analyst (LPA) B. Miranda arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with caregiver CF. Upon entry staff was observed wearing facial covering. LPA conduct tour with caregiver. Administrator Duane McAlister arrived later. Four residents were present during the tour. Visitor log-in/temperature check was observed upon entry.

Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. LPA did not observe cough etiquette and social distancing signs in common areas. Food supply was checked and there appeared to be an adequate supply. Cleaning supplies were stored and locked in cabinet. LPA checked resident's locked medications. All bathrooms are observed to have trash cans with lids, securely fastened grab bars, and non-skid mats. LPA observed hand washing posts by bathroom sinks. LPA observed kitchen and bathroom water temperatures at 132.4 degrees Fahrenheit. LPA toured 4 single occupant resident rooms furnished and adequately lit. LPA observed PPE supplies. Fire extinguisher observed to be last serviced 10/12/2022. Resident's files reviewed. LPA observed MARS & LIC622.

One citation issued due to water temperature reading at 132.4 degrees Fahrenheit.

Exit interview was conducted. Copy of report, citation, and appeal rights were provided to Administrator.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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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Document Has Been Signed on 01/26/2023 09:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MCALISTER'S RCFE	FACILITY NUMBER: 207202556
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(e)(2)

This requirement is not met as evidenced by: (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed water temperture in kitchen and bathroom as being 132.4 degrees Fahrenheit.
	POC Due Date: 02/02/2023
	Plan of Correction
1 2 3 4	Water heater temperature will be reset to fall between 105-120 degrees Fahrenheit. Pictures to verify will be sent to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

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