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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209043
Report Date: 07/15/2024
Date Signed: 07/22/2024 08:18:27 AM


Document Has Been Signed on 07/22/2024 08:18 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: 87DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Executive Director- Kelly ReynoldsTIME COMPLETED:
03:45 PM
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On 7/15/24, Licensing Program Analysts (LPAs) B. Miranda & M. Vega conducted a required unannounced Annual Inspection visit. LPAs introduced themselves and stated purpose of visit. Executive Director Kelly Reynolds was contacted and met with LPAs.


Facility has a capacity of 162 with a current census of 87. Residents have their own individual rooms with their own bathrooms. LPAs observed the facility to be clean, clutter free, and odor free.

LPAs reviewed infection control plan and disaster plans which are current and complete.

LPAs reviewed a sample of staff files which are complete and up to date. LPAs observed staff training to be current. LPA reviewed a sample of resident files which are complete and up to date.

Annual inspection was not completed at this time and will be completed at a later date.

No citations were issued during today's visit.

Exit interview was conducted and a copy of the report LIC809 was provided to Executive Director Kelly Reynolds
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024
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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