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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209030
Report Date: 04/23/2024
Date Signed: 04/24/2024 09:50:34 AM


Document Has Been Signed on 04/24/2024 09:50 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:LLC RETIREMENT HOMES IFACILITY NUMBER:
247209030
ADMINISTRATOR:LAMERSON, LINDSEYFACILITY TYPE:
740
ADDRESS:693 NORTHWOOD DRIVETELEPHONE:
(209) 582-2395
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:6CENSUS: 5DATE:
04/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Lindsey Lamerson - AdministratorTIME COMPLETED:
02:45 PM
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On 4/23/2024, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual inspection. LPA met with Licensee/Administrator Lindsey Lamerson and announced the purpose of the inspection. Administrator certificate is current with renewal date 2/5/2025. The facility has a hospice waiver for three residents, and there was one resident receiving hospice services at the time of inspection.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Fire extinguisher was recently serviced. Smoke and carbon monoxide detectors were present and operational. Outdoor area was free from hazard and had enough seating for residents in a covered area. The fence gate had a self-latching mechanism. LPA reviewed emergency disaster plan and record of emergency drills. There was an adequate supply of perishable and nonperishable foodstuffs. There was an adequate supply of emergency food and personal protective equipment. Medications were locked in a cabinet and appeared to be administered properly. Sharp items and detergents were secured and inaccessible to residents.

LPA toured bedrooms and bathrooms. Bedrooms were clean, odor free, and had required minimum furnishings. Bathrooms were clean and serviceable, and had required secure garb bars and non-skid mats. Facility had a extra towels, linens, and personal hygiene items for residents. Resident and staff files were reviewed and contained all required records. No deficiencies were cited during the inspection. A copy of the report was provided via email and exit interview conducted.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
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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