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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247206253
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:25:22 AM


Document Has Been Signed on 07/20/2023 11:25 AM - 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:INTEGRATED HEALTH CARE LLCFACILITY NUMBER:
247206253
ADMINISTRATOR:KRYSTYL SHEEN IBANEZFACILITY TYPE:
740
ADDRESS:1503 ESPLANADE DRIVETELEPHONE:
(209) 749-1009
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:6CENSUS: 6DATE:
07/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Krustal Sheen Ibanez - AdministratorTIME COMPLETED:
11:40 AM
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On 7/6/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with Administrator Krystal Sheen Ibanez and announced the purpose of the inspection. Administrator certificate was current with renewal date 10/1/2023.

LPA toured the facility inside and outside. Passageways and exits were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility was clean and odor free. LPA observed sufficient amount of perishable and non-perishable foodstuffs. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. Sharp items were secured in a locked drawer. A locked cabinet was observed to store resident medications, and medications appeared to be administered properly. LPA reviewed facility plan of operations and emergency disaster plan: last facility fire drill was conducted 7/10/2023. LPA reviewed a sample of resident files.

CCLD requested the following documents to update the facility file: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan, LIC 9020 Regirtser of Facility Residents, and a copy of current Administrator’s Certificate.
No deficiencies were cited during the inspection. Exit interview conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023
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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