<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208883
Report Date: 04/26/2023
Date Signed: 04/26/2023 04:09:23 PM

Document Has Been Signed on 04/26/2023 04:09 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:PEOPLE'S CARE AVENUE 344FACILITY NUMBER:
547208883
ADMINISTRATOR:SMITH, BILLIEJEANFACILITY TYPE:
738
ADDRESS:14453 AVENUE 344TELEPHONE:
(909) 287-3557
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 1DATE:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Administrators Billiejean Smith and Kristin Ennis, Lead Registered Behavior Technician Yadira PlasenciaTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/26/23 at 8:41 AM, Licensing Program Analyst (LPA) arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. LPA met with Administrators (ADMs) Billiejean Smith and Kristin Ennis, and Lead Registered Behavior Technician (RBT) Yadira Gamez-Plascencia. ADM Billiejean Smith left the inspection early.

LPA toured the facility with RBT and ADM Smith. LPA did not observe any obstructions. Bedrooms observed with sufficient lighting and furniture. Bathrooms observed with hand soap, paper towels, and toilet paper. Hand washing signs observed posted for each bathroom. Hot water measured 115.6 degrees F. Fire extinguisher observed last serviced 1/5/23. Medication is centrally stored in staff office. First aid kit observed complete. Sufficient food supply observed. Chemicals observed in cabinet in locked staff office. Resident and staff files reviewed. Administrator certificate valid. Delayed egress exterior door observed operational.

The following deficiencies were observed:
1. S1 did not have a completed transfer of Criminal Record Clearance for the facility and was present in the facility yesterday and today.
2. Fire exit gate for backyard was observed with missing pull chain.

Deficiencies are being cited based on LPA observations, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A civil penalty is being assessed in the amount of $100 per day, for 2 days, for a total of $200 for S1. See LIC421BG for more details.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Co-Administrator. A copy of this report and appeal rights were discussed and left with Co-Administrator Kristin Ennis, whose signature on this form confirms receipt of these documents.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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 8
Document Has Been Signed on 04/26/2023 04:09 PM - It Cannot Be Edited


Created By: Malia Thao On 04/26/2023 at 02:42 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: PEOPLE'S CARE AVENUE 344
FACILITY NUMBER: 547208883

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above. LPA found that the fire exit gate for the backyard was observed with a missing pull chain, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2023
Plan of Correction
1
2
3
4
Administrator will submit proof of installation of new pull chain for the backyard fire exit gate, to CCL by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 04/26/2023 04:09 PM - It Cannot Be Edited


Created By: Malia Thao On 04/26/2023 at 02:52 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: PEOPLE'S CARE AVENUE 344
FACILITY NUMBER: 547208883

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80065(i)(2)
80065 Personnel Requirements
(i) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:
(2) Request a transfer of a criminal record clearance as specified in Section 80019(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above. During the inspection, LPA found that S1 did not have a completed transfer of Criminal Record Clearance for the facility and was present in the facility yesterday and today, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2023
Plan of Correction
1
2
3
4
Licensee completed transfer of Criminal Record Clearance for S1 during the inspection. POC cleared.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023


LIC809 (FAS) - (06/04)
Page: 8 of 8