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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247208803
Report Date: 10/21/2024
Date Signed: 10/21/2024 02:50:35 PM


Document Has Been Signed on 10/21/2024 02:50 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:WESTSIDE ELDERLY CARE IFACILITY NUMBER:
247208803
ADMINISTRATOR:TOSTADO, MARIA HFACILITY TYPE:
740
ADDRESS:1243 SANTA MARIATELEPHONE:
(209) 826-7120
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:6CENSUS: 5DATE:
10/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Licensee Maria TostadoTIME COMPLETED:
03:00 PM
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On 10/21/24 Licensing Program Analyst (LPA) B. Miranda arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced herself, stated the purpose of the visit, and was granted entry to the facility. Licensee/Administrator Maria Tostado was at the facility.

LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior.
LPA observed the facility to be at a comfortable temperature, clean and odor free. Facility is free of debris, in good repair, and no obstructed passageways or fire hazards were observed. Common areas were properly furnished and well-lit throughout. Department phone number and infection prevention information signs were posted thought the facility.

Facility capacity is 6, with a current census of 5. Facility has 4 bedrooms and 3 bathrooms. Resident’s share bedrooms. Fire extinguishers have been services as of 11/6/2023 and are in good standing with charge. Smoke detectors and carbon monoxide detector were tested and are in working condition. Water temperature was checked in the kitchen and read at 109.9 degrees Fahrenheit, and checked in the common bathroom and read at 106.8 degrees Fahrenheit.

Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Knives, toxins, & cleaning supplies were observed to be locked and inaccessible to residents.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: WESTSIDE ELDERLY CARE I
FACILITY NUMBER: 247208803
VISIT DATE: 10/21/2024
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LPA reviewed a sample of Staff and Resident files. Resident & staff files were observed to be current and have updated information.

Under California Code of Regulations Title 22 no deficiencies were observed, and no citations were issued at this time.

Exit interview was conducted and a copy of this report LIC809 was provided to Licensee Maria Tostado.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
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