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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201437
Report Date: 01/06/2025
Date Signed: 01/06/2025 01:23:41 PM

Document Has Been Signed on 01/06/2025 01:23 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:DIAZ CARE HOME IIFACILITY NUMBER:
547201437
ADMINISTRATOR/
DIRECTOR:
ANTONIO DIAZFACILITY TYPE:
735
ADDRESS:2128 SOUTH ASHTON COURTTELEPHONE:
(559) 738-1008
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: 5DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Administrator Vanessa GardunoTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 01/06/2025, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was allowed entry staff. Administrator Vanessa Garduno was contacted and arrived a short while later.

LPA conducted tour with Staff. The facility was observed to be at a comfortable temperature, clean, in good repair, with no passageway obstructions or fire hazards. 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 12/3/2024 and was fully charged. All common areas were properly furnished and well-lit throughout. Medications, First Aid, Resident/Staff files, and Sharp items locked in the hallway closet. Smoke Alarm and Carbon Monoxide detector tested and operational.



LPA toured 3 resident rooms and a bathroom. All client bedrooms toured and observed to be adequately furnished. Extra linens observed in laundry room. LPA toured laundry area which appeared clean. Cleaning supplies and chemicals observed locked in in the laundry room closet. The exterior tour was conducted. Backyard observed to have sufficient seating under a patio umbrella. Medication was reviewed. Staff records were reviewed for good health and training, all clients’ records reviewed to have Admission Agreement, Physician’s Report and emergency contact information. Last fire drill completed on 12/4/2024.

LPA is requesting the following documents be submitted to the Fresno CCL office by 1/13/2025: 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 (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Administrator. Report signed on-site, a copy of the report will be emailed.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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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