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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202604
Report Date: 08/07/2024
Date Signed: 08/07/2024 03:06:18 PM

Document Has Been Signed on 08/07/2024 03:06 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/
DIRECTOR:		ADLER, WENDYFACILITY TYPE:
735
ADDRESS:301 REINDOLLAR AVETELEPHONE:
(831) 372-8002
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 4CENSUS: 4DATE:
08/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:23 PM
MET WITH:Administrator Wendy AdlerTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 8/7/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a case management visit regarding an incident report previously received from the facility. LPA met with Administrator Wendy Adler.

According to the Incident report there was a medication error with R1's medication. Incorrect dose was given. Administrator stated R1 had no side affects, and doctor was contacted.

Administrator stated training will be conducted next week and will provide verification to LPA when completed.
LPA reviewed R1's medication and centrally stored medication log. LPA observed medication to be logged properly.

No deficiencies were noted at this time and no citations were given at this time.

Exit interview was conducted and a copy of this report was provided to Administrator Wendy Adler.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
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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