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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208766
Report Date: 09/25/2024
Date Signed: 09/25/2024 01:43:59 PM

Document Has Been Signed on 09/25/2024 01:43 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SEQUOIA ADULT ACTIVITY CENTERFACILITY NUMBER:
547208766
ADMINISTRATOR/
DIRECTOR:		CONLEY, LORRIEFACILITY TYPE:
775
ADDRESS:1329 N ALTA AVETELEPHONE:
(559) 315-5351
CITY:DINUBASTATE: CAZIP CODE:
93618
CAPACITY: 30CENSUS: 26DATE:
09/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Administrator, Lorrie ConleyTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 09/25/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility by Administrator, Lorrie Conley.

LPA conducted a facility tour with Administrator. All passageways were clear from obstructions, no fire clearance issues were observed during today's inspection. LPA observed clients engaging in a group activity. LPA observed various activity rooms. Facility does not prepare meals on site, clients bring their lunches to program daily. Facility does not administer medications. LPA observed shelving units for client belongings. LPA toured facility restrooms. Restrooms observed to be operational. Hot water measured at 112.5 degrees F. Chemicals and knives are locked and inaccessible to clients in care. Fire extinguisher was last serviced on 07/23/2024.

Due to time constraints, LPA will return at a later date to review records.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Lorrie Conley, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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