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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204065
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:45:15 PM

Document Has Been Signed on 09/30/2024 02:45 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/
DIRECTOR:		LEWIS, KATHYFACILITY TYPE:
775
ADDRESS:226 E. FRONT STREETTELEPHONE:
(559) 747-1101
CITY:FARMERSVILLESTATE: CAZIP CODE:
93223
CAPACITY: 45CENSUS: 41DATE:
09/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Program Director Kathy LewisTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 9/30/2024, 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 Director Kathy Lewis.

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 different workstations and staff interacting with clients in an open classroom setting. Fire extinguisher in the Kitchen was last serviced on 8/5/2024 and was fully charged. Fire Drill was completed on 4/30/3024. 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 program also provides snacks. A tour of the kitchen was done, and all food storage and preparation appeared sanitary. Laundry area toured and observed clean. Cleaning supplies locked above laundry machines. Client’s records contained signed Admission Agreement, Personal Rights, and current Physician's Report and ID Documentation. Staff files were reviewed for good health. It was verified that current staff on duty are CPR certified.

No deficiencies issued during inspection.

The following documents are requested and need to be submitted to Fresno CCL office by 10/7/2024:Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020.

Report signed on-site by Program Director; a printed copy was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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