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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209408
Report Date: 06/07/2024
Date Signed: 06/11/2024 09:59:42 PM


Document Has Been Signed on 06/11/2024 09:59 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:
06/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Administrator Khushbir MannTIME COMPLETED:
09:45 AM
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On 6/7/2024 Licensing Program Analyst (LPA) B. Miranda arrived at facility announced to complete an Pre-Licensing visit. LPA met with Administrator (AD) Khushbir Mann.

LPA observed the previous deficiencies to be corrected. The window screens had been replaced, grab bars were added to the master bathroom, a wall was added to the master bedroom. The wall was added due to the master bedroom having two closets. This allows one of the closets to be locked and used for cleaning supplies and allows the resident who will resident in the master bedroom to have privacy.

Pre-licensing inspection has been completed. COMP III was provided to Administrator Khushbir Mann to complete and was completed.

Exit interview was conducted and a copy of this report was provided to Administrator Khushbir Mann.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024
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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