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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247202428
Report Date: 09/04/2024
Date Signed: 09/04/2024 06:59:02 PM


Document Has Been Signed on 09/04/2024 06:59 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: 70DATE:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 AM
MET WITH:Resident Care Director Mani SongoimoliTIME COMPLETED:
01:45 PM
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On 09/04/2024, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct a case management inspection. LPA met with Resident Care Director Mani Songoimoli and announced the purpose of the inspection.

During this visit LPA toured the facility inside and out to conduct residents safety check. The purpose of the visit was to follow-up on an incident which occurred on 8/10/2024. On 8/10/2024, Resident (R1) was found in her room partially undressed in bed with her husband. During staff interview R1 responded no to consensual relationship with her husband. On 8/22/2024, facility staff reassessed R1's care needs. At this time resident at highest level of care (6) and it has not changed.

During this visit LPA requested facility files for review.

No citations were issued at this time. Exit interview conducted, report signed and copy of this report provided for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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