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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209172
Report Date: 02/05/2024
Date Signed: 02/08/2024 09:55:39 AM


Document Has Been Signed on 02/08/2024 09:55 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: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: 16DATE:
02/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Executive Director- Krista WillsonTIME COMPLETED:
02:15 PM
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On 2/5/24, Licensing Program Analyst (LPA) B. Miranda conducted an unannounced Annual Required visit. LPA introduced self, stated purpose of visit, and was allowed entrance. LPA met with Executive Director Krista Willson and Administrator Elizabeth Reynaga.

LPA toured the facility inside and out to include kitchen, dining/living room area, sample of bedrooms, and sample of bathrooms. LPA observed the facility to be clean, free from clutter, and odor free. Facility has a current census of 16 with a capacity of 50.

All fire exit routes were clear and free from obstructions. Fire extinguishers were current and in good standing. Water temperature read at 111.9 degrees Fahrenheit in the Heartland community bathroom. Water was also tested in a resident's bathroom and read at 106.8 degrees Fahrenheit. Medications are stored in a locked room. Toxins, cleaning supplies, knives and sharp objects are secured and inaccessible to residents.

Facility has shared rooms and private rooms. Each room has it's own bathroom.


Smoke alarms were previously test by an outsource company and are in working condition.

LPA reviewed a sample of staff files which are current and up to date. LPA reviewed a sample of resident files which were current with proper documentation.

No citations issued per the California Code of Regulations Tittle 22.

Exit interview was conducted with Executive Director Krista Willson and Administrator Elizabeth Reynaga, copy of report LIC809 was provided to Krista Willson.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2024
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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