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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209142
Report Date: 09/08/2023
Date Signed: 09/08/2023 02:24:51 PM


Document Has Been Signed on 09/08/2023 02:24 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:OAKHURST BOARD AND CAREFACILITY NUMBER:
207209142
ADMINISTRATOR:LEANG, LUCYFACILITY TYPE:
740
ADDRESS:41456 PAMELA PLACETELEPHONE:
(559) 293-3174
CITY:OAKHURSTSTATE: CAZIP CODE:
93644
CAPACITY:11CENSUS: 5DATE:
09/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Administrator Designee- Ester JacksonTIME COMPLETED:
02:45 PM
NARRATIVE
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On 9/8/23 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct an annual inspection. LPA was greeted by staff and allowed entry into the facility. Ester Jackson Administrator Designee arrived to the facility at a later time.

LPA toured the facility inside and out. Facility currently has 5 residents. LPA observed the facility to be clean, free from clutter, and odor free. All faucets delivered water within temperature limits of 105-120 degrees F. Fire extinguishers were last serviced 5/2/23. Carbon monoxide and smoke detectors were tested and in working order.

LPA observed a sample of residents files and staff files which have proper information. LPA observes resident's rooms to be properly furnished and at comfortable temperatures.

LPA observed cleaning products, knives, and medication to be locked and inaccessible to residents.

LPA observed Centrally Stored Medication log to not be properly completed. Citation issued on LIC809D.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were given to Administrator Designee- Ester Jackson
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023
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 09/08/2023 02:24 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: OAKHURST BOARD AND CARE
FACILITY NUMBER: 207209142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(a)(6)
Incidental Medical and Dental Care Services
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.

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. Centrally Stored Medication log was not properly completed.
POC Due Date: 09/15/2023
Plan of Correction
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Administrator Desginee- Ester Jackson will be retraining the staff. Verification of training will be sent to LPA by 9/15/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023
LIC809 (FAS) - (06/04)
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