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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209172
Report Date: 11/18/2024
Date Signed: 11/18/2024 06:47:53 PM

Document Has Been Signed on 11/18/2024 06:47 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/
DIRECTOR:		REYNAGA, ELIZABETHFACILITY TYPE:
740
ADDRESS:555 MILLER LANETELEPHONE:
(209) 710-4783
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY: 50TOTAL ENROLLED CHILDREN: 0CENSUS: 26DATE:
11/18/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:48 PM
MET WITH:Executive Director Krista WillsonTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
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On 11/18/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a health and safety case management visit. LPA introduced herself and explained the reason for the visit and met with Executive Director (ED) Krista Willson and Administrator (AD) Elizabeth Reynaga.

The facility reported to LPA, R1 who is currently at the hospital testing positive for fentanyl. The Emergency room reached out to the facility to inform. This medication is not prescribed to R1.

LPA toured the facility and verified medications are locked and inaccessible to residents in care. LPA observed residents to be interacting with one another and with staff. ED stated none of the residents have been prescribed fentanyl.

LPA did not observe any deficiencies and no citation were issued. Follow-up visit may be conducted at another time.


Exit interview was conducted and a copy of this report was provided to Executive Director (ED) Krista Willson and Administrator (AD) Elizabeth Reynaga.
Brenda ChanTELEPHONE: (650) 266-8800
Brianna MirandaTELEPHONE: 559-770-0254
DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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