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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204065
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:40:24 PM

Document Has Been Signed on 11/29/2023 02:40 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:HERBS AND MORE ADULT DAY PROGRAMFACILITY NUMBER:
547204065
ADMINISTRATOR:LEWIS, KATHYFACILITY TYPE:
775
ADDRESS:226 E. FRONT STREETTELEPHONE:
(559) 747-1101
CITY:FARMERSVILLESTATE: CAZIP CODE:
93223
CAPACITY: 45CENSUS: 39DATE:
11/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Program Manager Linda RosaTIME COMPLETED:
03:00 PM
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On 11/29/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced to conduct an Annual Inspection. LPA was allowed entry by staff. LPA completed a tour of the facility with Program Manager Linda Rosa.

The Day Program facility is clean and maintained at a good temperature. LPA observed adequate seating and lighting throughout the facility. No passageway obstructions. Quiet room observed. No fire hazards were observed inside or outside. Client restrooms were toured, observed to be clean, and operational. Day Program does not dispense medications. Cleaning supplies were observed behind locked door, in the staff bathroom. LPA observed all the different workstations and staff interacting with clients. Fire extinguisher in the Kitchen was last serviced on 8/1/2023 and was fully charged. Last fire drill completed on 10/27/2023. The Fire Department tested the pull-down alarm on 10/24/2023. Carbon Monoxide detector tested and operational. The program does not handle client medications. The clients have access to various activities, reading, working outdoors and writing was observed. The program also provides lunch and has a rotating lunch schedule. The menu was looked at and had balanced meals for lunch. The program also provides snacks. A tour of the kitchen was done, and all food storage and preparation appeared sanitary.

A sample of client files were also reviewed to have updated emergency contact information, TB Tests, and IPP’s. Staff files have current 1st Aid. At 1:23 LPA discovered two staff currently employed and working at the facility that are not associated.

Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,
Division 6.

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SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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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Document Has Been Signed on 11/29/2023 02:40 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 11/29/2023 at 02:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: HERBS AND MORE ADULT DAY PROGRAM
FACILITY NUMBER: 547204065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)(3)
Criminal Record Clearance
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (3) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f); or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 17 staff members were not associated with the facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2023
Plan of Correction
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Licensee to remove staff members from premises immediately. Staff may not return to work until they are associated with the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023


LIC809 (FAS) - (06/04)
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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: HERBS AND MORE ADULT DAY PROGRAM
FACILITY NUMBER: 547204065
VISIT DATE: 11/29/2023
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An exit interview was conducted. The following documents are requested and need to be submitted to Fresno CCL by 12/06/23. Designation of Facility Responsibility LIC308, Administrator Organization LIC309, Personnel Report LIC500, Emergency and Disaster Plan LIC610D, and Register of Facility Clients LIC9020.

Report signed on-site by Program Manager; a printed copy was provided with appeal rights. An Immediate Civil penalty is assessed.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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