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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547200150
Report Date: 04/03/2023
Date Signed: 04/03/2023 12:41:03 PM

Document Has Been Signed on 04/03/2023 12:41 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:DIAZ FAMILY CARE HOMEFACILITY NUMBER:
547200150
ADMINISTRATOR:DIAZ, DIANNA & ANTONIOFACILITY TYPE:
735
ADDRESS:1603 S. PEPPERTREE CT.TELEPHONE:
(559) 635-4360
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: 4DATE:
04/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Administrator Vanessa GardunoTIME COMPLETED:
12:30 PM
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On 4/03/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA was allowed entry by Administrator Vanessa Garduno.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed. Hand sanitizer was readily available to residents and visitors. Sharp items and medications are locked in hallway closet. Cleaning supplies were locked and secured in laundry room. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in the kitchen was last serviced on 12/6/2022 and was fully charged. Common areas were properly furnished and well-lit throughout.

LPA toured 3 bedrooms with one shared bedroom and two single occupants. LPA observed 1 live in staff bedroom. All clients’ bedroom toured and observed to be adequately furnished and lit and restrooms observed to be clean, odor free and functioning at time of visit. The exterior tour was conducted. Backyard observed to have sufficient seating. Backyard gate was self-latching and self-closing. Medication was reviewed. Staff records were reviewed for good health and infection control training. All clients’ records reviewed to have updated emergency contact information. Last fire drill: 03/01/23.

No deficiencies issued during this inspection.



LPA is requesting the following documents be submitted to the Fresno CCL office by 4/10/2023: Current copy
of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization
(LIC309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan
(LIC610E), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Licensee. Report signed on-site; and a printed copy was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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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