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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209172
Report Date: 02/21/2023
Date Signed: 02/22/2023 02:09:15 PM


Document Has Been Signed on 02/22/2023 02:09 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:VALLEY SPRING MEMORY CAREFACILITY NUMBER:
247209172
ADMINISTRATOR:REYNAGA, ELIZABETHFACILITY TYPE:
740
ADDRESS:555 MILLER LANETELEPHONE:
(209) 710-4783
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:50CENSUS: 6DATE:
02/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator- Krista WillsonTIME COMPLETED:
03:00 PM
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On 2/21/23 at 1:05 p.m. Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct an annual inspection. LPA was greeted by S1 and allowed entrance into the facility. Covid pre-screening was completed. LPA explained the reason for the visit and Administrator (AD) Krista Willson was contacted. AD met with LPA and conducted tour.

LPA toured the facility inside and out. Fire extinguishers were current and in good standing. Water temperature read at 111.3 degrees Fahrenheit in the Heartland community bathroom.

LPA observed all exits to be clear and free from obstruction. LPA observed residents in the common area of the "neighborhood" in Heartland. Current census is 6. Four of the six residents have their own rooms, and two residents share a room.

LPA observed kitchen with 2 days worth of perishable food items and 7 days worth of non-perishable food items, all opened food was labeled. Kitchen is not accessible to residents.

LPA observed bathrooms to be clean and stocked with soap and paper towels. LPA observed community showers with pull bars and non-slip mats. LPA observed chemicals were locked away and inaccessible to residents. LPA observed medication to be locked and inaccessible to residents.

Covid-19 mitigations plan was reviewed.

No deficiencies were cited during the inspection. Exit interview was conducted and a copy of this report was provided to AD Krista Willson.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023
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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