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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208766
Report Date: 09/06/2023
Date Signed: 09/06/2023 10:19:49 AM

Document Has Been Signed on 09/06/2023 10:19 AM - 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:SEQUOIA ADULT ACTIVITY CENTERFACILITY NUMBER:
547208766
ADMINISTRATOR:CONLEY, LORRIEFACILITY TYPE:
775
ADDRESS:1329 N ALTA AVETELEPHONE:
(559) 315-5351
CITY:DINUBASTATE: CAZIP CODE:
93618
CAPACITY: 30CENSUS: 22DATE:
09/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Lorrie Conley, Licensee/AdministratorTIME COMPLETED:
10:35 AM
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On 9/6/23 at 9:46 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a POC visit for deficiencies issued on 8/24/23. LPA explained reason for inspection and was granted entry by Administrator (ADM) Lorrie Conley.

LPA observed the following corrected:

1. Right side fence panel of south side pool fence observed with screws in top left and bottom right sides; outlet in bathroom observed with face plate replaced; and latch of north side exit gate observed tighten and nails nailed down.
2. Garage access door's lock doorknob switched so that key is required to access the garage from inside the facility.

Deficiencies cleared.

Exit interview conducted. A copy of this report was given to Licensee, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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