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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206290
Report Date: 11/03/2023
Date Signed: 11/03/2023 03:44:41 PM

Document Has Been Signed on 11/03/2023 03:44 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:KAISER SPECIALIZED RESIDENTIAL TAYLORFACILITY NUMBER:
547206290
ADMINISTRATOR:MICHELLE VASQUEZFACILITY TYPE:
735
ADDRESS:2816 W TAYLOR AVETELEPHONE:
(559) 636-2590
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 3DATE:
11/03/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Emily Carpenter, AdministratorTIME COMPLETED:
02:55 PM
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On 11/3/23 at 1:20 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual continuation. LPA contacted Administrator (ADM) Emily Carpenter and explained reason for inspection. Staff arrived to facility and granted entry. ADM arrived a short time later.

LPA toured the facility and reviewed records. Due to unforeseen circumstances, LPA was not able to complete the inspection and will return to complete the Inspection Tool at a later date.

Exit interview conducted. A copy of this report will be emailed to ADM with "Read receipt" to confirm receipt of this report. ADM is unavailable to sign today's report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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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