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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201437
Report Date: 01/24/2024
Date Signed: 01/30/2024 09:01:46 AM

Document Has Been Signed on 01/30/2024 09:01 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:DIAZ CARE HOME IIFACILITY NUMBER:
547201437
ADMINISTRATOR:ANTONIO DIAZFACILITY TYPE:
735
ADDRESS:2128 SOUTH ASHTON COURTTELEPHONE:
(559) 738-1008
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: DATE:
01/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Administrator Vanessa GardunoTIME COMPLETED:
10:30 AM
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On 1/24/2024, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. Administrator Vanessa Garduno opened the door and informed LPA a resident tested positive for COVID on Monday 1/22/2024 . Administrator stated everyone was in isolation. LPA inquired if Administrator had informed CCLD. Administrator stated she was not aware she still needed to report to CCLD. LPA advised Administrator to submit a incident report and LPA will conduct the annual at a later date.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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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