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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208783
Report Date: 02/20/2024
Date Signed: 02/20/2024 12:17:41 PM

Document Has Been Signed on 02/20/2024 12:17 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:FRONTIER IN THE WESTFACILITY NUMBER:
547208783
ADMINISTRATOR:MARTINEZ, ARGELIAFACILITY TYPE:
737
ADDRESS:32083 MANOTA CTTELEPHONE:
(559) 735-9564
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 4DATE:
02/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Argelia Martinez and Program Liaison Antoinette Moore TIME COMPLETED:
12:30 PM
NARRATIVE
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On 02/20/24, Licensing Program Analyst (LPA) M. Yang conducted the case management visit to the facility. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with lead staff Hector Duarte. Administrator Argelia Martinez and Program Liaison Antoinette Moore was called and arrived shortly.

The purpose of the case management visit is to address incident that occurred on 02/03/24 where staff administered medication to C1 not as followed by physician’s order.

A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D.

Exit Interview conducted. A copy of this report and appeal rights was provided to the Administrator, whose signature on this form confirms receipt of these report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/20/2024 12:17 PM - It Cannot Be Edited


Created By: Mai Yang On 02/20/2024 at 12:06 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: FRONTIER IN THE WEST
FACILITY NUMBER: 547208783

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2024
Section Cited
CCR
80075(b)(5)(B)

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80075(b) (5) (B)Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidenced by:

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Administrator stated that S2 was retrained Health-Related Services regulations on 02/16/24. S1 is no longer employed by the facility. Copy of training topic and staff attendance rooster was received. POC cleared during visit.
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Based on interviews conducted, C1’s PRN medication Magnesia 400mg/5ml was prescribed to be administered after 3 days without bowel movements. Staff administered medication to client two days after no bowel movement. Medication was administered to client not as ordered by physician which poses an immediate health and safety risks to persons in care.
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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:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024


LIC809 (FAS) - (06/04)
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