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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247206554
Report Date: 03/05/2025
Date Signed: 03/07/2025 09:15:27 AM

Document Has Been Signed on 03/07/2025 09:15 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:KAZLIN INFINITE CARE LLCFACILITY NUMBER:
247206554
ADMINISTRATOR/
DIRECTOR:		ERLINDA MAGLIBAFACILITY TYPE:
740
ADDRESS:3554 EL REDONDO DRIVETELEPHONE:
(209) 349-8457
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY: 6CENSUS: 4DATE:
03/05/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:41 PM
MET WITH:house manager Maria FloresTIME VISIT/
INSPECTION COMPLETED:
03:42 PM
NARRATIVE
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On 03/05/2025, On 08/08/2024 Licensing Program Analyst (LPA) V Gorban visited the facility stated above to conduct case management. This visit resulted in regard to complaint investigation and file review

During this visit LPA conducted safety check by touring the facility and observing and interviewed clients in care, interviewed staff, administrator and reviewed facility files. Staff and resident's files were reviewed for required information. Based on residents file review and staff interview records for R1 and R2 were not up to date.

The deficiency issued on attached LIC 809-D

Exit interview conducted, report signed and copy of this report with appeal rights provided to the facility administrator.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/07/2025 09:15 AM - It Cannot Be Edited


Created By: Vadim Gorban On 03/05/2025 at 10:46 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KAZLIN INFINITE CARE LLC
FACILITY NUMBER: 247206554

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2025
Section Cited

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87506 Resident Records. (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not observe das evidenced by:
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The facility administrator failed to follow title 22 regulation by maintaining current resident files, which poses potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Vadim Gorban
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2