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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202604
Report Date: 01/31/2023
Date Signed: 02/13/2023 09:15:21 PM

Document Has Been Signed on 02/13/2023 09:15 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:REINDOLLAR ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
275202604
ADMINISTRATOR:ADLER, WENDYFACILITY TYPE:
735
ADDRESS:301 REINDOLLAR AVETELEPHONE:
(831) 372-8002
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 4CENSUS: 4DATE:
01/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:04 PM
MET WITH:Administrator- Wendy AdlerTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) B. Miranda conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Caregiver S1. S1 completed the tour with LPA.
Administrator Wendy Adler arrived to the facility shortly after LPA's arrival.

Facility has 4 residents, LPA observed 2 residents in the living room which is a common area, and one in the shower. One resident had their grandmother visiting. LPA toured the facility inside and out. All fire exit routes were free and clear of obstructions. LPA observed a supply of PPEs. Fire extinguishers were services 11/10/2022.
LPA observed kitchen as clean and free from clutter. Facility has 7 days worth of non-perishable items and 2 days worth of perishable items. LPA observed knives as being locked and inaccessible to residents.
LPA observed medication lock and inaccessible to residents. Kitchen water temperature read at 112.6 degrees Fahrenheit.

Facility has designated entry point for COVID 19 symptom screening and temperature check. Bathroom was not observed at this time due to resident showering. Facility observed to be supplied with hygiene products and hand washing signs posted. Hand sanitizer available for residents, staff and visitors. Postings included Visitor Policy, Keep Safe Wear a Mask, How Can I Protect Myself, Symptoms of COVID 19, COVID 19 When to Seek Care, Stop the Spread, Cough Etiquette, Six Feet Apart and Donning and Doffing of PPEs.

LPA reviewed 2 residents files with recent LIC602 completed. Administrator's profile has current CPR card. Mitigation plan was reviewed.
No citations issued per the California Code of Regulations Tittle 22.
LPA reviewed report with Wendy Adler Administrator and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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