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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209408
Report Date: 05/17/2024
Date Signed: 05/20/2024 04:43:35 PM


Document Has Been Signed on 05/20/2024 04:43 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:SEVA CARE HOMEFACILITY NUMBER:
247209408
ADMINISTRATOR:MANN, KHUSHBIRFACILITY TYPE:
740
ADDRESS:1072 DALLAS DRIVETELEPHONE:
(916) 509-0875
CITY:LIVINGSTONSTATE: CAZIP CODE:
95334
CAPACITY:6CENSUS: 0DATE:
05/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:52 PM
MET WITH:Administrator Khushbir MannTIME COMPLETED:
03:15 PM
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On 5/17/2024 Licensing Program Analyst (LPA) B Miranda arrived at facility announced to complete an Pre-Licensing visit. LPA met with Administrator (AD) Khushbir Mann.

LPA toured the facility inside and out. During the tour LPA observed 4 bedrooms and 2 bathrooms to be properly furnished for residents. Two bedrooms are for single resident use and two bedrooms are for shared.

LPAs observed the following deficiencies:
1. Outside screens facing the street need to be repaired.
2. Grab bars need to be added to the master bathroom.
3. Cleaning supplies will be moved from closet in master bedroom to different locked area


Pre-licensing is incomplete with deficiencies to be resolved by 5/31/24. Photos will be sent to LPA to show deficiencies have been corrected.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024
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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