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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247200745
Report Date: 02/23/2024
Date Signed: 02/26/2024 06:55:07 PM


Document Has Been Signed on 02/26/2024 06:55 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: 38DATE:
02/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Sister Lucinda FonsecaTIME COMPLETED:
07:30 PM
NARRATIVE
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On 2/23/24, Licensing Program Analyst (LPA) B. Miranda conducted a required unannounced Annual Inspection visit. LPA introduced self, stated purpose of visit, was allowed entrance and met with Sister Lucinda Fonseca.

LPA toured the facility inside and out to include entry, kitchen, dining, bedrooms, bathrooms, and exterior. All fire exit routes were free and clear of obstructions. LPA observed the facility to be clean free from clutter, and odor free. Medications are stored in a locked cabinet in individual wings. LPA observed a small kitchen in the activities room to be unlocked and contained knifes and cleaning supplies. Other storage spaces containing toxins & cleaning supplies were locked. LPA checked the water temperature in a common bathroom in D wing which read at 125.2 degrees Fahrenheit.

Facility has license for capacity of 76, and current census is 38. Resident’s do not share bedrooms, and each bedroom has their own bathrooms.
Fire extinguishers have been services as of 3/22/23 and are in good standing. Smoke alarms are tested periodically throughout the year.

LPA observed a sample of resident's medications. LPA observed R1's medication to show in the MAR as given, but was still in the bubble pack.

Deficiencies were noted and citations issued per the California Code of Regulations Tittle 22.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Sister Lucinda Fonseca.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 02/26/2024 06:55 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: NEW BETHANY
FACILITY NUMBER: 247200745

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. Water read at 125.2 degrees Fahrenheit in the common bathroom in the D wing.
POC Due Date: 02/26/2024
Plan of Correction
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Maintenance will come out and check water heaters. Sister Lucinda will follow-up with LPA.
Type A
Section Cited
CCR
87309(a)
Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed kitchen in activity room to be unlocked with knife and chemicals accessible to residents.
POC Due Date: 02/26/2024
Plan of Correction
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Room was immediately locked. Facility will remove all items, and send verification to LPA.
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: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 02/26/2024 06:55 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: NEW BETHANY
FACILITY NUMBER: 247200745

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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 an immediate health, safety or personal rights risk to persons in care. Medication count for R1 was marked as been given and was still in bubble pack.
POC Due Date: 02/26/2024
Plan of Correction
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Facility will conduct an in-service, verification will be sent to LPA.
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: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3