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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275200905
Report Date: 05/16/2024
Date Signed: 05/20/2024 10:56:38 AM

Document Has Been Signed on 05/20/2024 10:56 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:SOLEDAD SVSFACILITY NUMBER:
275200905
ADMINISTRATOR/
DIRECTOR:		DIANA CASTANEDAFACILITY TYPE:
775
ADDRESS:757 FRONT STREETTELEPHONE:
(831) 678-9431
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY: 60CENSUS: 48DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:52 AM
MET WITH:Administrator Diana CastanedaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 5/16/24, Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a required Annual Inspection visit. LPA met with Administrator Diana Castaneda. LPA explained the reason for the visit.

LPA toured the facility inside and out including both entrances & exits, facility's 6 classrooms, and 4 bathrooms. LPA observed facility to be clean, clutter free, and odor free. LPA observed clients and staff interacting with one another.

One fire exit route to the back of the building was locked requiring a key to unlock, which causes the exit to be obstructed. Administrated stated medication is not given or kept at the facility. LPA observed cleaning supplies being stored under the kitchen sink without being locked. LPA observed janitor's closet open allowing toxins & cleaning supplies to be accessible to clients. LPA also observed paints & glue being stored on a shelf that is not able to be locked. Multiple disinfectants were found in unlocked cabinet in the exercise room.

Fire extinguishers have been services as of 8/23/23 and are in good standing. Carbon monoxide detector was tested and in working condition. Water temperature was checked in the kitchen and read at 107.2 degree Fahrenheit.

LPA reviewed staff and client files. LPA observed staff training to not meet the required annual training of 8 hours.

Citations were issued per the California Code of Regulations Title 22.
Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights was/were provided to Administrator Diana C.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 05/20/2024 10:56 AM - It Cannot Be Edited


Created By: Brianna Miranda On 05/16/2024 at 01:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SOLEDAD SVS
FACILITY NUMBER: 275200905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065.1(d)(1)
Personnel Qualifications and Duties
(1) Direct care staff shall receive a minimum of 8 hours a year of training, documented.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA did not observed staff training to meet the required 8 hours of annual training.
POC Due Date: 05/24/2024
Plan of Correction
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AD will update training form to reflect proper time is documented for annual training.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Brianna Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/20/2024 10:56 AM - It Cannot Be Edited


Created By: Brianna Miranda On 05/16/2024 at 02:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SOLEDAD SVS
FACILITY NUMBER: 275200905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. During the tour of the facility LPA observed kitchen sink to have cleaning supplies stored underneath with no lock and accessible to clients. LPA also observed janitor's closet to be open across the bathrooms in the facility allowing accessibility of cleaning supplies to clients. LPA observed paints and glue to be accessible to clients, and the exercise classroom had disinfectants accessible to client's.
POC Due Date: 05/17/2024
Plan of Correction
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AD will provide pictures to LPA, and plan will be sent to LPA by 5/24/24.
Type A
Section Cited
CCR
82020
All day programs shall secure through the licensing agency and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed one of the exits from the back of the building to be locked, requiring a key to unlocked. This exit is a fire exit and should accessible for an emergency exit during the time clients are in program..
POC Due Date: 05/17/2024
Plan of Correction
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AD will provide picture of gate unlocked. Plan of correction will be sent to LPA by 5/24/24
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Brianna Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
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