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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202056
Report Date: 09/06/2024
Date Signed: 09/09/2024 05:58:23 PM

Document Has Been Signed on 09/09/2024 05:58 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:CIELO VISTAFACILITY NUMBER:
275202056
ADMINISTRATOR/
DIRECTOR:		MARK CASTILLOFACILITY TYPE:
735
ADDRESS:806 ELM AVENUETELEPHONE:
(831) 674-2180
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY: 40CENSUS: 40DATE:
09/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:56 PM
MET WITH:Administrator, Mark CastilloTIME VISIT/
INSPECTION COMPLETED:
05:48 PM
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On 09/06/2024 Licensing Program Analyst (LPA) V Gorban arrived unannounced for an Annual Required Inspection. LPA met at the door with Administrator Mark Castillo, administrator certification number 6022513735 expiration date 11/18/2024. LPA stated the purpose of the visit and was allowed entry. During this visit LPA toured facility with AD inside and out. Facility has two main entrance/exit points.

The facility appeared clean, comfortable temperature recorded at 75 degrees Fahrenheit with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Bathrooms have trash cans with lids. The exterior tour was conducted. The facility licensed for 20 shared rooms. Every room is fully furnished. LPA reviewed clients files including for emergency contact and physician report.

Kitchen observed with free of clutter and obstruction. The kitchen refrigerator was checked. LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Refrigerator observed at 36 degrees and freezer at 4 degrees Fahrenheit.

Cleaning supplies were observed to be locked in a hallway cabinet. Clients’ records were reviewed. Fire extinguisher in compliance, service date 10/02/2023.

Medications were observed to be locked in med cart located in med room. Facility uses QuicMar to document administration/ dispense and track clients’ medications. First aid kit was observed and contained all required items.
Carbon monoxide and smoke detectors were tested and observed to be operational.

Exit interview was conducted. No citations were issued on this visit. Copy of this report printed and provided for facility records.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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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