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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201863
Report Date: 08/07/2024
Date Signed: 08/07/2024 10:19:02 PM


Document Has Been Signed on 08/07/2024 10:19 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:ANJELICA'S VILLAFACILITY NUMBER:
275201863
ADMINISTRATOR:NERISSA RAMOSFACILITY TYPE:
740
ADDRESS:555 FRANCIS AVETELEPHONE:
(831) 899-2644
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY:40CENSUS: 18DATE:
08/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Administrator Nerissa RamosTIME COMPLETED:
01:30 PM
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On 8/7/2024 Licensing Program Analyst (LPA) B. Miranda arrived unannounced at the facility to conduct an Annual Inspection. LPA introduced herself and explained the reason for the visit. LPA met with Administrator Nerissa Ramos. Administrator certificate is current.

LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPA observed the facility to be at a comfortable temperature of 72, clean and odor free. LPA did not observe obstructions of fire exits or fire hazards. Common areas were properly furnished and well-lit throughout. Department phone number and infection prevention information signs were posted thought the facility.

Facility capacity is 40, with a current census of 18. Residents do not share bedrooms. Fire extinguishers have been services as of 9/28/2023 and are in good standing with charge. Water temperature was checked in the two common bathroom used for bathing the residents and read at 105 & 120 degrees Fahrenheit.

LPA observed the required 7-day supply of non-perishable food and 2- day supply of perishables food items to be properly stored. Knives & cleaning supplies were observed to be locked and inaccessible to residents.

LPA reviewed a sample of Staff files which are current and training is up to date. Sample of resident files were reviewed.

Follow-up visit will be conducted to complete Annual inspection. Deficiencies will be noted and cited at follow-up visit. Follow-up visit will address no audio alarms on the exits and S1 not having proper background clearance. Medications will be reviewed during follow-up visit.

Exit interview was conducted and a copy of this report LIC809 was emailed to Administrator Nerissa Ramos
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024
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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