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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207202556
Report Date: 11/07/2024
Date Signed: 12/12/2024 02:04:11 PM

Document Has Been Signed on 12/12/2024 02:04 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 RCFEFACILITY NUMBER:
207202556
ADMINISTRATOR/
DIRECTOR:		MC ALISTER, DUANEFACILITY TYPE:
740
ADDRESS:11976 RD 36 1/2TELEPHONE:
(559) 645-1861
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:53 PM
MET WITH:Staff Carol HolleyTIME VISIT/
INSPECTION COMPLETED:
06:30 PM
NARRATIVE
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On 11/7/2024 Licensing Program Analyst (LPA) B. Miranda arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced herself, stated the purpose of the visit, and was granted entry to the facility. Licensee/Administrator Duane McAlister was contacted but was not able to attend the visit. Staff Carol Holley conducted the tour with LPA.

LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPA observed the facility to be at a comfortable temperature, clutter & odor free. Facility is free of debris and no passageway are obstructed and no fire hazards were observed. Common areas were properly furnished and well-lit throughout.

Facility capacity is 6, with a current census of 4. Residents do not share bedrooms. Fire extinguishers have been services as of 9/17/24 and are in good standing with charge. Smoke detectors and carbon monoxide detector were tested and are in working condition. Water temperature was checked in the kitchen and read at 105.1 degrees Fahrenheit.

Inspecting the kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Knives & cleaning supplies were observed to be locked and inaccessible to residents. R1 has a DX of dementia and LPA observed scissors and screwdrivers in the kitchen drawers.
Brenda ChanTELEPHONE: (650) 266-8800
Brianna MirandaTELEPHONE: 559-770-0254
DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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 12/12/2024 02:04 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: 11/07/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personal Accommodations and Services
(e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools or similar bodies of water, when not in active use by residents, through fencing, covering or other means.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed the far left side of the pool gate to be missing. The pool is considered accessible to residents
POC Due Date: 11/08/2024
Plan of Correction
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Licensee will provide proof fence has been fixed.
Section Cited
(f) The following shall be stored inaccessible to residents with dementia:

(1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed scissors & screwdrivers in kitchen drawer.
POC Due Date: 11/08/2024
Plan of Correction
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Staff will remove and secure in inaccessible location.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Brenda ChanTELEPHONE: (650) 266-8800
Brianna MirandaTELEPHONE: 559-770-0254

DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/12/2024 02:04 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: 11/07/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Diabetes
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other supplies are maintained and stored in the facility as specified in Section 87465(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, & record review, 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 R1 to have a glucose meter listed with their medications, facility does not have a meter, or current physician's report. Last physician's report from 8/25/22 indicates R1 cannot test themselves.
POC Due Date: 11/28/2024
Plan of Correction
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Licensee will send LPA a plan of correction to rectify the situation.
Section Cited
(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & interview, 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 rodent droppings under the kitchen sink, kitchen cabinets needing to be cleaned on the inside and outside, and dish rack needing to be cleaned.
POC Due Date: 11/28/2024
Plan of Correction
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Licensee will provide pictures to verify corrections have been made.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Brenda ChanTELEPHONE: (650) 266-8800
Brianna MirandaTELEPHONE: 559-770-0254

DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/12/2024 02:04 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: 11/07/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & interview, 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 bathroom cabinets to be dirty and cabinet doors missing from hallway bathroom.
POC Due Date: 11/28/2024
Plan of Correction
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Licensee will provide pictures verifying corrections have been made.
Section Cited
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, 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 did not observe current training for dementia.
POC Due Date: 11/28/2024
Plan of Correction
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Licensee will provide verification of current training for dementia.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Brenda ChanTELEPHONE: (650) 266-8800
Brianna MirandaTELEPHONE: 559-770-0254

DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024

LIC809 (FAS) - (06/04)
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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
VISIT DATE: 11/07/2024
NARRATIVE
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LPA did not observe all resident files to have current emergency information or physician report. LPA did not observe staff to have current training for dementia.
LPA is requesting the following due by 11/28/24: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A), and current liability insurance.

Under California Code of Regulations Title 22 the following deficiencies were observed, and citations were issued.
  • Pool is accessible to residents on the far left side (left side of the gate is missing)
  • Scissors and screwdrivers were in unlocked kitchen drawer and accessible to residents
  • R1 has a glucose meter prescribed and R1 listed as not being able to test themselves, facility has no meter
  • Kitchen needs cleaning under sink, inside & outside of cabinets
  • Bathrooms cabinets are dirty and hallway bathroom is missing cabinet doors
  • Staff do not have current dementia training on file.


Exit interview was conducted and a copy of this report LIC809, LIC809D, LIC421IM and appeal rights were provided to Staff Carol Holley.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
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