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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209043
Report Date: 07/27/2023
Date Signed: 09/28/2023 04:57:16 AM


Document Has Been Signed on 09/28/2023 04:57 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:CEDAR CREEK SENIOR LIVINGFACILITY NUMBER:
207209043
ADMINISTRATOR:JACKSON, SHAWNIEEFACILITY TYPE:
740
ADDRESS:500 N. WESTBERRY BLVD.TELEPHONE:
(559) 673-2345
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:162CENSUS: 62DATE:
07/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Resident Care Director Kimberly JonesTIME COMPLETED:
06:45 PM
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On 7/27/2023 at 9:45 a.m. Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct an annual inspection. LPA entered the facility and was greeted by the receptionist. LPA asked to speak with Joan Johnson who is the potential administrator. Resident Care Director Kimberly Jones was contacted and informed LPA Joan was not available. LPA completed tour with Generations Program Director- Lupe Fierros. Currently the facility does not have an active Administrator.

LPA toured the facility inside and out. LPA checked water temperature in resident's bathroom which read at 113.7 degrees F. LPA observed multiple fire extinguishers to last be serviced 2/21/23 and still have charge. Facility's capacity is 162, and currently there is 62 residents. All residents have their own apartments unless they are sharing with a spouse. LPA observed a sample resident bedrooms which were properly furnished, had adequate lighting, and storage space. Sample of residents stated they can control the temperature in their apartments.
Verification was provided from Direct Supply indicating smoke detectors were last tested on 11/17/22. Facility was not able to provide verification of carbon monoxide detectors being tested.

Due to time constraints annual inspection was not completed at this time. Deficiencies and citations will be issued at a later date. LPA will return to the facility at a later date or an appointment at the Regional Office will be scheduled.

Exit interview was conducted with Resident Care Director Kimberly Jones
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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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