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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206648
Report Date: 03/18/2025
Date Signed: 03/18/2025 03:35:36 PM

Document Has Been Signed on 03/18/2025 03:35 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/
DIRECTOR:		HERNANDEZ, GLADYSFACILITY TYPE:
735
ADDRESS:5712 SUNNYSIDE DRTELEPHONE:
(559) 802-3065
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 4CENSUS: 4DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:28 AM
MET WITH:Administrator Gladys Hernandez and Staff Dee RoseTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 3/18/2025, Licensing Program Analyst LPA K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. Administrator Gladys Hernandez and was contacted and arrived a short time later with quality assurance staff Dee Rose. LPA conducted tour with Administrator. The facility was observed to be at a comfortable temperature, clean, in good repair, with no passageway obstructions or fire hazards. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in the Kitchen was last serviced on 11/13/2024 and was fully charged. All common areas were properly furnished and well-lit throughout. Medications observed locked in hallway cabinets. First Aid, Resident/Staff files in facility office. LPA observed unlocked chemicals and sharps in the facility office. Sharps locked in kitchen cabinet. Dual Smoke Alarm and Carbon monoxide detector tested and operational.

LPA toured 4 resident rooms and two bathrooms. All client bedrooms toured and observed to be adequately furnished. Extra linens observed in the hallway closet. LPA toured laundry area which appeared clean in the garage The exterior tour was conducted. Backyard observed to have sufficient seating under covered enclosed patio. LPA observed backyard gate could not be opened due to draw string on the outer side of the fence. A second gate in-front of the house was rusted and would not open. During Medication Audit; LPA observed Centrally Stored Medication and Destruction Report Log had incorrect information. Staff records were reviewed for good health and training, all clients’ records reviewed to have Admission Agreement, Physician’s Report and emergency contact information. Last fire drill completed on 1/2/2025

Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

Continued to LIC 809C
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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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: SAILS SUNNYSIDE
FACILITY NUMBER: 547206648
VISIT DATE: 03/18/2025
NARRATIVE
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LPA is requesting the following documents be submitted to the Fresno CCL office by 3/25/2025: 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 (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2025 03:35 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 03/18/2025 at 02:39 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: SAILS SUNNYSIDE
FACILITY NUMBER: 547206648

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)

(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 observation, the licensee did not comply with the section cited above in one out of one area; Faciity office was observed with unlocked chemicals and sharps which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/19/2025
Plan of Correction
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 Administrator agrees to remove the unlocked items to a locked area and submit proof by due date.
Type A
Section Cited
CCR
80020(a)
Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in one out of one; Both fire exit gates outside the facility were inaccessible from inside backyard. Administrator could not open the inside wooden gate from inside yard due to draw string on the outer side of the fence. A second gate in-front of the house was rusted and would not open; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/19/2025
Plan of Correction
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Administrator called maintenance individual to repair the rust on the outer gate and replaced the latch on the wooden fence 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:See Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 03/18/2025 03:35 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 03/18/2025 at 02:57 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: SAILS SUNNYSIDE
FACILITY NUMBER: 547206648

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85068.4(f)

85068.4 Acceptance and Retention Limitations (f) The Department may require the licensee to comply with various regulations applicable to RCFEs if the Department determines that compliance with any such specific regulations is necessary to protect the health and safety of clients 60 years of age or older. Such regulations may include, but not be limited to, those pertaining to the training of staff members who assist clients with personal activities of daily living; the regular observation of clients for changes in physical, mental, emotional, and social functioning; and the notification of the client's physician and responsible person and/or authorized representative, if any, of documented changes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 5 out of 5 staff were not trained with RCFE training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2025
Plan of Correction
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Plan of Correction POC Licensee agrees to meet training regulations for staff pertaining to residents 60 and over. Administrator agrees to submit type of training for staff, hours trained, list of staff trained and who conducted training by POC due date of 5/19/2025


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: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
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