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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240404746
Report Date: 08/16/2023
Date Signed: 08/16/2023 04:13:57 PM

Document Has Been Signed on 08/16/2023 04:13 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:BATON ROUGEFACILITY NUMBER:
240404746
ADMINISTRATOR:LYNNE ZIMMERMANFACILITY TYPE:
735
ADDRESS:3172 BATON ROUGETELEPHONE:
(209) 723-2710
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 6CENSUS: 4DATE:
08/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Staff- Jade MoralesTIME COMPLETED:
04:15 PM
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On 8/16/2023 at 3:43 p.m. Licensing Program Analyst (LPA) B. Miranda and SGAI Jacqueline Juarez arrived to the facility unannounced to conduct a case management. Joslyn Petersen and Jade Morales were contacted and informed case management was being conducted a trust audit regarding resident's PNI money.

Jade stated she is the administrator for all three facilities.

SAGI spoke with Joslyn and informed LIC500, resident's bank statements, Policy/Procedures for PNI, and Policy/Procedures regarding residents staying home will need to be provided by 8/30/23.

Emergency contact information and PNI listings were scanned.

Facility currently has 4 residents, one resident is currently in the hospital. 3 of the 4 residents currently have money at the facility. Facility has R1 as managing their own money, admission agreement states Licensee will be responsible for all personal and incidental expenses of money, all money is currently accessible to resident on a debit card. Licensee will follow-up with CVRC regarding R1's funds.

LPA and SGAI verified money being kept at the facility matches the resident's ledger. All money is signed and accounted for.

No discrepancies were found at this time and no citations were issued.



Exit interview was conducted and a copy of this report LIC809 was provided to Jade.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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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