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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202056
Report Date: 07/21/2023
Date Signed: 07/24/2023 08:04:17 AM

Document Has Been Signed on 07/24/2023 08:04 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:CIELO VISTAFACILITY NUMBER:
275202056
ADMINISTRATOR:MARK CASTILLOFACILITY TYPE:
735
ADDRESS:806 ELM AVENUETELEPHONE:
(831) 674-2180
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY: 40CENSUS: 40DATE:
07/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrative assistant, Ana BidesTIME COMPLETED:
03:00 PM
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On 7/21/2023, Licensing Program Analyst (LPA) V Gorban conducted an unannounced Case Management visit to the facility stated above.

LPA introduced self and was allowed entrance by staff. LPA Gorban met with administrative assistant Ana Bides. Administrator was notified of licensing but was unable to attend the visit.

LPA toured facility inside and out, observed residents in dining room during lunch. LPA Gorban reviewed facility residents’ (R1) file. LPA attempted to interview R1 but R1 was not in the facility. Facility maintained up to date resident’s files following Title 22.

No deficiencies cited during this Case Management visit.

Exit interview was conducted with administrative assistant, report signed on-site, and a copy of this report was provided for facility records.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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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