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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202604
Report Date: 10/04/2023
Date Signed: 10/04/2023 05:05:31 PM

Document Has Been Signed on 10/04/2023 05:05 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:
10/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:28 PM
MET WITH:Administrator Wendy AdlerTIME COMPLETED:
05:15 PM
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On 10/4/2023 at 3:28 p.m. Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct a case management inspection - incident inspection. LPA explained reason for inspection and met with Administrator (AD) Wendy Adler.

LPA was following-up on an incident report received on 10/3/23 by e-fax. Incident was regarding R2 and S3. AD will revise incident report and submit to LPA by end of business day 10/5/23.

LPA interviewed AD and S1 regarding the incident and what took place regarding the incident.

Staff meeting was conducted on 9/28/23 which included the issue regarding the incident that took place (inappropriate language being used). Training was also completed this month. AD will provide S3's current training.

S3 was placed on administrative leave and has since returned to work after internal investigation was conducted.

No citation was issued at this time.

A copy of this report was provided to Administrator Wendy Adler.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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