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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204082
Report Date: 12/21/2022
Date Signed: 12/21/2022 02:23:16 PM

Document Has Been Signed on 12/21/2022 02:23 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:ABARQUEZ HOMES INC.FACILITY NUMBER:
547204082
ADMINISTRATOR:ANDRES, RICARDOFACILITY TYPE:
735
ADDRESS:312 NW 4TH STREETTELEPHONE:
(559) 741-1296
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 4DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Ricardo Andres, AdministratorTIME COMPLETED:
03:00 PM
NARRATIVE
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On 12/21/22 at 9:08 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reasonf for inspection and was granted entry by staff. LPA met with Administrator (ADM) Ricardo Andres.

Facility has COVID-19 precaution signs posted and conducted temperature check of visitor. LPA toured inside and outside of the facility. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and residents do not share bedrooms. LPA checked residents’ medications. Cleaning and PPE supplies were checked. Resident files have updated emergency contact information.

The following deficiencies were observed:
1. Facility does not have a carbon monoxide detector.
2. LPA observed the blade in blender on kitchen countertop accessible; one shovel and one pick garden tool observed outside in front walkway garden bed accessible; miscellaneous garden tools, tool box, insect spray and caulking tube observed accessible in unlocked garage.
3. Administrator on record does not have a current Administrator certification.
4. LPA observed lights not working in bedrooms #1,2, and 4, living room, and bathroom next to bedroom #4; light switch in bedroom #4 and living room observed broken with missing switch; toilet seats were missing from bathrooms next to bedroom #1/2 and 4; air vent in ceiling of bedroom #2 observed covered in dust; backsplash behind kitchen sink observed peeling from wall and not clean, and doorknob to front gate in porch area observed broken and inoperatable.
5. LPA observed a sliding wooden door installed separating kitchen from dining area that is locked with a key.
6. LPA observed R2's bedroom closet locked with a padlock.

Continue on LIC809-C.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 12
Document Has Been Signed on 12/21/2022 02:23 PM - It Cannot Be Edited


Created By: Malia Thao On 12/21/2022 at 12:36 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: ABARQUEZ HOMES INC.
FACILITY NUMBER: 547204082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1503.2
General Provisions
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above. Facility does not have a carbon monoxide detector, which poses an immediate safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
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Administrator will submit proof of purchase and installation of a carbon monoxide detector in the facility, to CCL by POC due date.
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above. LPA observed the blade in blender on kitchen countertop accessible; one shovel and one pick garden tool observed outside in front walkway garden bed accessible; miscellaneous garden tools, tool box, insect spray and caulking tube observed accessible in unlocked garage, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/21/2022
Plan of Correction
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Administrator immediately locked door to laundry room (room leading to unlocked garage), locked blender in secured laundry room closet, removed shovel and pick tool to garage during the inspection. POC cleared during inspection.
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/21/2022 02:23 PM - It Cannot Be Edited


Created By: Malia Thao On 12/21/2022 at 12:36 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: ABARQUEZ HOMES INC.
FACILITY NUMBER: 547204082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above. LPA observed lights not working in bedrooms #1,2, and 4, living room, and bathroom next to bedroom #4; light switch in bedroom #4 and living room observed broken with missing switch; toilet seats were missing from bathrooms next to bedroom #1/2 and 4; air vent in ceiling of bedroom #2 observed covered in dust; backsplash behind kitchen sink observed peeling from wall and not clean, and doorknob to front gate in porch area observed broken and inoperable. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/04/2023
Plan of Correction
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Administrator removed inoperable doorknob from front gate in porch area during the inspection. Administrator will submit proof of all lights operational in bedrooms #1,2, 4, living room, and bathroom by bedroom #4; light switches in bedroom #4 and living room will be replaced; new toilet seats installed for toilets in bathrooms by bedroom #1/2 and 4; air vent in bedroom #2 cleaned; backsplash behind kitchen sink cleaned and repaired, to CCL by POC due date.
Type B
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above. LPA observed a sliding wooden door installed separating kitchen from dining area that is locked with a key, which poses a potential safety or personal rights risk to persons in care.
POC Due Date: 01/04/2023
Plan of Correction
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Administrator will submit proof of sliding wooden door removed, to CCL by POC due date.
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


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Document Has Been Signed on 12/21/2022 02:23 PM - It Cannot Be Edited


Created By: Malia Thao On 12/21/2022 at 12:45 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: ABARQUEZ HOMES INC.
FACILITY NUMBER: 547204082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
85064(b)
85064 Adminstrator Qualifications and Duties
(b) All adult residential facilities shall have a certified administrator.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, interview, record review, the licensee did not comply with the section cited above. Administrator on record does not have a current Administrator certification, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
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Administrator will submit proof of completed Administrator Re-certification application, check paid to ACS (Administrator Certification Section) in the amount of $200, and proof of certified mailing label addressed to ACS, to CCL by POC due date.
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


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Document Has Been Signed on 12/21/2022 02:23 PM - It Cannot Be Edited


Created By: Malia Thao On 12/21/2022 at 12:51 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: ABARQUEZ HOMES INC.
FACILITY NUMBER: 547204082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80072(a)(3)
80072 Personal Rights (a)… client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment…other actions of a punitive nature, including but not limited to:…withholding of…clothing...

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above. LPA observed R2's bedroom closet locked with a padlock, which poses a potential personal rights risk to persons in care.
POC Due Date: 01/04/2023
Plan of Correction
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Administrator will submit proof of written statement that facility will obtain an approved exception from CCL before locking R2's closet, to CCL by POC due date.
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


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: ABARQUEZ HOMES INC.
FACILITY NUMBER: 547204082
VISIT DATE: 12/21/2022
NARRATIVE
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Continued from LIC809.

Deficiencies are being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D.

The following updated forms are to be submitted to CCL within 2 weeks:

LIC610D (new revision), LIC500, LIC400, LIC402, LIC9020

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Administrator Ricardo Andres, whose signature on this form confirms receipt of these documents.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
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