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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209354
Report Date: 11/07/2023
Date Signed: 11/13/2023 10:51:27 AM

Document Has Been Signed on 11/13/2023 10:51 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:JOY J. ADULT RESIDENTIAL CARE HOMEFACILITY NUMBER:
247209354
ADMINISTRATOR:MUTUA, CATHERINEFACILITY TYPE:
735
ADDRESS:263 ARROYO CTTELEPHONE:
(510) 292-1577
CITY:MERCEDSTATE: CAZIP CODE:
95341
CAPACITY: 6CENSUS: 0DATE:
11/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator - Catherine Mutua TIME COMPLETED:
11:10 AM
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On 11/7/2023, Licensing Program Analyst(LPA) D. Ayers arrived at the facility to conduct an announced Pre-Licensing Inspection. LPA met with Administrator Catherine Mutua.

LPA met with Licensee and toured the facility inside and outside. Pathways and doors were clear and free from obstruction. Smoke detectors and carbon monoxide detectors were present and operational. Facility fire extinguishers were present and recently serviced. Facility was clean and odor free. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, had required secure grab bars and non-skid mats, and water temperature was within required temperature range. Sharp items were secured in a locked drawer in the kitchen. A secured area is prepared to store medication in a locked closet. The fences had self-latching mechanisms and there were no outdoor hazards. There is adequate outdoor covered seating for residents. LPA reviewed facility plan of operations and emergency disaster plan.

Pre-Licensing is complete and this facility has no deficiencies. Administrator completed Component III. Exit interview was conducted, and a copy of the report was provided via email.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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