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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247206554
Report Date: 10/11/2023
Date Signed: 10/11/2023 12:32:11 PM


Document Has Been Signed on 10/11/2023 12:32 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:KAZLIN INFINITE CARE LLCFACILITY NUMBER:
247206554
ADMINISTRATOR:ERLINDA MAGLIBAFACILITY TYPE:
740
ADDRESS:3554 EL REDONDO DRIVETELEPHONE:
(209) 349-8457
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:6CENSUS: 4DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jasmin Burns - ManagerTIME COMPLETED:
12:40 PM
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On 10/11/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual Inspection. LPA met with Manager Jasmin Burns and announced the purpose of the inspection. Administrator certificate is current with expiration date 2/3/2025.

During the inspection, LPA toured the facility inside and outside. Exits and passageways were clear and free from obstruction. Smoke detectors, carbon monoxide detectors, and fire extinguisher were present and operational. LPA reviewed facility Emergency and Disaster Plan. Common areas were clean, odor free, adequately lit, and provided comfortable seating for all residents. The facility was at a comfortable temperature and the thermostat read 76 degrees Fahrenheit. Chemicals, detergents, and cleaning supplies were secured in locked cabinets. The facility had an adequate supply of clean linens and blankets. LPA observed a sufficient supply of personal protective equipment and reviewed facility infection control practices to meet requirements. LPA observed a sufficient supply of perishable and nonperishable foodstuffs. Refrigerator and freezer were clean and food items were stored and marked properly.

LPA toured resident bedrooms and bathrooms. Bedrooms and bathrooms were clean, odor free, and had required minimum furnishings. There were three residents receiving hospice care services at the time of inspection. Bathrooms had required secure grab bars and non-skid mats, and water temperature was within acceptable temperature range. Resident medications were secured in a locked cabinet in the kitchen area. LPA reviewed three residents' medications and medications and medication administration records, and medications appeared to be administered properly. LPA reviewed a sample of staff files and all resident files: required records were present in resident and staff files.

No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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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