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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 355202781
Report Date: 09/24/2024
Date Signed: 09/24/2024 02:23:14 PM

Document Has Been Signed on 09/24/2024 02:23 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:BAUTISTA HOMEFACILITY NUMBER:
355202781
ADMINISTRATOR/
DIRECTOR:		MITCHELL GUEVARAFACILITY TYPE:
737
ADDRESS:777 OLYMPIATELEPHONE:
(831) 818-7981
CITY:SAN JAUN BAUTISTASTATE: CAZIP CODE:
95045
CAPACITY: 4CENSUS: 4DATE:
09/24/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensee, Dr. Heidi MorganTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On 09/24/2024, 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

Dr. Heidi Morgan, Licensee and Chief Executive Officer
David Sandhu, Director of Operations

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

Health Related Services, medications
Client records/safeguards for cash resources.


Report continues on LIC809-C
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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: BAUTISTA HOME
FACILITY NUMBER: 355202781
VISIT DATE: 09/24/2024
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The facility Licensee agreed to do the following in order to bring the facility into compliance no later than 09/25/2024:

The facility AD and staff agreed to provide a plan in writing describing how the facility shall ensure compliance on subject matter identified above by providing prevention plan and following documents: LIC308, LIC500, and LIC309

The Licensee 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 Technical Support Program resources at www.cdss.ca.gov and department will follow up with the facility on it.

Exit interview conducted and a copy of this report provided to the Licensee Dr Heidi Morgan

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

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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