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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247200650
Report Date: 09/13/2022
Date Signed: 09/13/2022 01:47:01 PM


Document Has Been Signed on 09/13/2022 01:47 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:ALEXANDER RESIDENTIAL CARE HOMEFACILITY NUMBER:
247200650
ADMINISTRATOR:AMPARO CULLENFACILITY TYPE:
740
ADDRESS:1728 E. ALEXANDER AVENUETELEPHONE:
(209) 383-2326
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:6CENSUS: 0DATE:
09/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Licensee Amparo CullenTIME COMPLETED:
02:00 PM
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On 9/13/2022, Licensing Program Analyst (LPA) K. Kaur arrived at the above facility to conduct a case management - closure inspection. The purpose of the inspection is for a voluntary closure. LPA introduced self, stated the purpose of the visit, and met with Licensee Amparo Cullen.

LPA conducted a final tour with License and observed all Residents have been removed and relocated. Licensee surrendered her RCFE license. Closure inspection is complete.

No deficiencies issued.

An exit interview was conducted with Licensee. Report signed on site and printed copy provided. Facility closure will be processed upon LPA’s return to the office.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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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