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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209043
Report Date: 01/25/2024
Date Signed: 01/26/2024 08:16:11 AM


Document Has Been Signed on 01/26/2024 08:16 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:ELDRIDGE, KIMBERLYFACILITY TYPE:
740
ADDRESS:500 N. WESTBERRY BLVD.TELEPHONE:
(559) 673-2345
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:162CENSUS: 67DATE:
01/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Executive Director Kelly M & Administrator Kimberly ETIME COMPLETED:
01:15 PM
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On 01/25/24 at 12:55 p.m.Licensing Program Analyst (LPA) B. Miranda entered the facility unannounced to collect original reporst and provide amended reports. LPA was greeted and met with Executive Director Kelly Reynolds & Administrator Kimberly Elderidge. LPA explained the reason for the visit.


LPA explained the original reports needed to be collected due to report needing to be amended. LPA collected the original reports and provided a copy of the amended LIC9099s to Executive Director Kelly Reynolds.

Exit interview conducted, original reports were collected, and a copy of the amended reports provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
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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