<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 355201055
Report Date: 07/02/2024
Date Signed: 07/02/2024 03:55:21 PM


Document Has Been Signed on 07/02/2024 03:55 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:WHISPERING PINES INN, LLCFACILITY NUMBER:
355201055
ADMINISTRATOR:PARK,CHARLES & MAEFACILITY TYPE:
740
ADDRESS:476 LOS VIBORAS ROADTELEPHONE:
(831) 636-9620
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:36CENSUS: 19DATE:
07/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Charles Park - AdministratorTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/2/2024, Licensing Program Analyst's (LPA's) D. Ayers and M. Vega arrived unannounced at the facility to conduct a Required Annual Inspection. LPA's met with Licensee/Administrator Charles Park and announced the purpose of the inspection.

LPA's toured the facility inside and outside. Pathways and exits were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility was clean and odor free. LPA's observed sufficient amount of perishable and non-perishable foodstuffs, and facility kitchen was observed to be clean. Common areas were clean, adequately furnished, and adequately lit. Outdoor areas were free from hazards and provided adequate seating and area for residents. The facility was equipped with a back-up generator and three wells which provide fresh water. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. Sharp items were secured in a locked drawer. Medications were secured in locked cabinets within a medication room. Medications appeared to be administered properly. LPA reviewed facility plan of operations and emergency disaster plan. LPA reviewed a sample of resident files and staff files and training records.

No deficiencies were cited during the inspection. Exit interview conducted with Licensee and a copy of the report was provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1