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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247200745
Report Date: 03/01/2023
Date Signed: 03/01/2023 06:17:50 PM


Document Has Been Signed on 03/01/2023 06:17 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:NEW BETHANYFACILITY NUMBER:
247200745
ADMINISTRATOR:FONSECA, JULIAFACILITY TYPE:
740
ADDRESS:1441 BERKELEY DRIVETELEPHONE:
(209) 827-8933
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:76CENSUS: DATE:
03/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Administrator Sister Lucinda FonsecaTIME COMPLETED:
03:00 PM
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On 3/1/23 at 2:30 p.m. Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced. LPA met with Administrator Sister Lucinda Fonseca, and explained the reason for the visit.

On 2/21/23 LPA conducted an annual inspection. LPA forgot to have AD sign the LIC809 for the inspection. FAS specialist verified there was no signature in the representative box.

LPA explained the situation to AD and had AD sign LIC809 for annual inspection on 2/21/23 and today’s LIC809 for this visit.

LPA did not conduct a tour since the visit was only to obtain signature for the annual inspection report (LIC809).

Exit interview was conducted. Due to printer not having ink LIC809 from today and LIC809 from 2/21/23 were emailed to AD.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2023
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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