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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247202941
Report Date: 04/29/2024
Date Signed: 04/29/2024 12:57:54 PM

Document Has Been Signed on 04/29/2024 12:57 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:DAVIDSON HOMEFACILITY NUMBER:
247202941
ADMINISTRATOR/
DIRECTOR:
DAVIDSON, RHONDAFACILITY TYPE:
735
ADDRESS:3328 COLUMBIA DRIVETELEPHONE:
(209) 626-5014
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 6CENSUS: 6DATE:
04/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:33 AM
MET WITH:Licensee Rhonda DavidsonTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 4/23/24, 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 Licensee.

Facility capacity is 6 and the current census is 6. Facility has 6 bedrooms and 2 bathrooms. Two of the six residents share a room, all other residents have their own rooms.

LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathroom, and exterior. All fire exit routes were free and clear of obstructions. Medications are stored in a locked closest in the hallway. Toxins, cleaning supplies, knives and sharp objects are secured and inaccessible to residents.

Fire extinguishers have been services and are in good standing. Smoke alarm was tested and is in working condition. Carbon monoxide detector was tested and in working condition. Water temperature was checked in the kitchen and read at 114.4 degree Fahrenheit.

LPA reviewed a sample of staff files which were complete and update to date. LPA reviewed a sample of resident files which were complete and up to date.

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 Licensee Rhonda Davidson.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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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