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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206648
Report Date: 02/23/2023
Date Signed: 02/23/2023 12:55:44 PM

Document Has Been Signed on 02/23/2023 12:55 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:SAILS SUNNYSIDEFACILITY NUMBER:
547206648
ADMINISTRATOR:NORALBA MAGANAFACILITY TYPE:
735
ADDRESS:5712 SUNNYSIDE DRTELEPHONE:
(559) 802-3065
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 4CENSUS: 4DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Administrator Gladys HernandezTIME COMPLETED:
01:00 PM
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On 2/23/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA met with Administrator Gladys Hernandez and stated the purpose of the visit. LPA requested documents be submitted to update Administrator on file.

Visitor log-in/temperature check, masks, and disinfection station were observed upon entry. Facility has one
entrance/exit point. Facility staff observed with facial coverings. Facility has no obstruction or fire clearance
issues. Hand sanitizer was readily available to residents and visitors. Hand washing and other various
Covid-19 related signs were observed in the common areas. Sharp items and medications are locked in the
Kitchen cabinet. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Cleaning supplies and chemicals are locked in the office. Fire extinguisher in the kitchen was last serviced on 6/29/2022 and was fully charged. Trash cans observed with lids. Hand washing posters were observed in the bathrooms by the sink. Medication observed to be locked in the hallway cabinets. A sample of medication was reviewed. Staff and resident records were reviewed for updated emergency contact information and health screening.

No deficiencies issued during this inspection.

LPA is requesting the following documents be submitted to the Fresno CCL office by 2/14/2023: 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
(LIC610E), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Administrator. Report signed on-site and printed copy provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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