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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 355202661
Report Date: 09/12/2024
Date Signed: 09/13/2024 06:25:16 AM

Document Has Been Signed on 09/13/2024 06:25 AM - 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:BLUE RIVER 2FACILITY NUMBER:
355202661
ADMINISTRATOR/
DIRECTOR:		COOK, DEANEFACILITY TYPE:
735
ADDRESS:2607 GLENVIEW DRTELEPHONE:
(831) 635-9169
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 6CENSUS: 6DATE:
09/12/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Administrator Deane CookTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
NARRATIVE
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On 09/12/2024, a scheduled informal meeting was conducted via teleconference. The purpose of the informal meeting was to discuss recently identified issues associated with the operation of the facility and to provide support on the subject matter. Informal meeting process was explained during this meeting.

Present at the informal meeting were:

Licensing Program Analyst, Vadim Gorban
Licensing Program Manager, Brenda Chan

Licensee/Administrator Deane Cook
Facility supervisor Luz Lopez Sanchez
Direct Support Personnel, Vanessa Sanchez
On call Supervisor Paola Camarena

This meeting was called to discuss the following issues or deficiencies:

Facility records
Care and Supervision


Report continues on LIC809-C
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: BLUE RIVER 2
FACILITY NUMBER: 355202661
VISIT DATE: 09/12/2024
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The facility Administrator (AD), Deane Cook agreed to do the following in order to bring the facility into compliance no later than 09/27/2024:

The facility AD and staff agreed to provide a plan of correction in writing describing how the facility shall ensure compliance with the facility records and care and supervision.

The Administrator has been advised that failure to complete the above agreed action by the date will result in this Department taking following actions:

CCLD may increase monitoring to ensure the facility's adherence to this plan of compliance. CCLD may take administration action against the Licensee.

The Licensee was provided and accepted Technical Support Program and resources at www.cdss.ca.gov

Exit interview conducted and a copy of this report provided to the Administrator Deane Cook.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC809 (FAS) - (06/04)
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