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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247202428
Report Date: 04/25/2024
Date Signed: 04/25/2024 01:02:29 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/25/2024 01:02 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:PARK MERCEDFACILITY NUMBER:
247202428
ADMINISTRATOR:ELINA MOILANENFACILITY TYPE:
740
ADDRESS:3050 M STREETTELEPHONE:
(209) 722-3944
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:125CENSUS: 67DATE:
04/25/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Administrator Elina MoilanenTIME COMPLETED:
01:30 PM
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On 4/25/24, Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a required Annual Inspection visit. LPA introduced herself, stated purpose of visit, and was allowed entrance by staff. Administrator Elina Moilanen was contacted and met with LPA.

LPA toured the facility inside and out including entry, kitchen, dining, common areas, sample of bedrooms, sample of bathrooms, and exterior. LPA observed facility to be clean, clutter free, and odor free. All fire exit routes were observed to be free and clear of obstructions. Medications are stored in a locked room. Toxins, cleaning supplies are kept in a locked room. Knives and sharp objects are securely locked and inaccessible to residents.

Facility is licensed for a capacity of 125 and the current census is 67. Residents have their own bedrooms and do not share. The facility has 94 individual bedrooms with private bathrooms in each room. Disaster plan is complete and current. Emergency drills are conducted on a quarterly basis. Liability insurance is current with proper coverage.

Fire extinguishers have been services as of 10/5/23 and are in good standing. Fire sprinkler system was last serviced 4/3/24. A carbon monoxide detector was tested in a common area and is in working condition. Water temperature was checked in a residents bedrooms and read at 117.1 degrees Fahrenheit.

Sample of resident files and staff files were reviewed. Training, CPR, and first aid are current and up to date for sample files.

No citations issued per the California Code of Regulations Title 22.

Exit interview was conducted and a copy of this report LIC809 was provided to Administrator Elina Moilanen.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
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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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: PARK MERCED
FACILITY NUMBER: 247202428
VISIT DATE: 04/25/2024
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Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below:

Residential Care Facility for the Elderly (RCFE):


· LIC 308 Designation of Facility Responsibility
· -as applicable: LIC 309 Administrative Organization
· -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources
· -as applicable: LIC 402 Surety Bond
· LIC 500 Personnel Report
· LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly
· LIC 9020 Register of Facility Clients/Residents
· Copy of current Liability Insurance
· Copy of current Administrator Certificate
· Alternate contact information including name, telephone number, & email address.

Please submit the above forms/information to Fresno CCL by: 05/02/2024

As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
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