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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208766
Report Date: 10/11/2024
Date Signed: 10/11/2024 10:14:39 AM

Document Has Been Signed on 10/11/2024 10:14 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
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:
10/11/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Administrator, Lorrie ConleyTIME VISIT/
INSPECTION COMPLETED:
10:28 AM
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On 10/11/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management - annual continuation inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Administrator, Lorrie Conley.

On 09/25/2024, an annual inspection was conducted and LPA completed the physical plant tour of the facility. Due to time constraints, LPA ended the inspection and informed Administrator that an annual continuation inspection will be conducted to review facility records.

During today's inspection, LPA reviewed the facility records and found the following: Client and personnel records were reviewed and found to be complete. LPA observed current needs and services plans and medical assessments for clients. LPA observed first-aid/CPR certification, criminal record statements, and health screens for personnel. Facility infection control plan was reviewed. Emergency disaster plan reviewed. Facility's last fire drill was conducted on 10/02/2024.

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: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
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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