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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208958
Report Date: 07/11/2026
Date Signed: 07/13/2026 09:58:38 AM

Document Has Been Signed on 07/13/2026 09:58 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:VISALIA SENIOR LIVING CAREFACILITY NUMBER:
547208958
ADMINISTRATOR/
DIRECTOR:		RAMOS, ANGELAFACILITY TYPE:
740
ADDRESS:310 EAST ROBIN AVETELEPHONE:
(559) 747-2182
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 6CENSUS: 5DATE:
07/11/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator, Angela RamosTIME VISIT/
INSPECTION COMPLETED:
06:16 PM
NARRATIVE
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On 07/11/26 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Care Giver, Demtria Ribuca and Helen Jabian, explained reason for visit and was permitted entry into the facility. Administrator, Angela Ramos was contacted and arrived a short time later. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 5 of 5 residents present during todays visit.1 resident currently receiving hospice services at this time. The facility is a 4 bedroom/2 bath facility.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Fire extinguisher last serviced 01/06/26. Last fire drill on conducted on 06/10/26. Resident rooms observed to have the required furnishings and with adequate lighting. LPA observed sufficient seating under covered patio areas.

The following issues were observed during today’s visit: Supplements observed on kitchen table and in refrigerator unsecured. Chemicals observed in garage and laundry room unlocked and accessible. Freezer in garage in need of cleaning. Food observed in garage freezer and pantry in kitchen observed not properly stored or dated. 3 of 5 residents observed with full bed rails without a prescription. Bedroom fan light observed without light bulbs and exposed sockets. Knife and lighter observed in kitchen drawer next to stove unlocked and accessible. Pizza and other food items requiring refrigeration observed in pantry. Bedroom window screen observed torn and in need of repair. ViBack yard gate and side gate listed as a fire exit observed locked and inaccessible. Medication prescribed is not listed on the MARS being used by the facility.

CONT...

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mary Garza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2026
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: VISALIA SENIOR LIVING CARE
FACILITY NUMBER: 547208958
VISIT DATE: 07/11/2026
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CONT...

Proper hand hygiene not observed with staff and resident care. Insulin medication observed in kitchen refrigerator on shelf unlocked and accessible. Fire door from living room to hallway was observed propped open with a chair. Due to IT issues Licensee will be called in for an office meeting. If warranted, deficiencies will be issued in office.

Deficiency for Fire clearance issued during visit on LIC809D. If not corrected, deficiency will have an immediate impact to residents in care. *****An immediate civil penalty in the amount of $500 assessed*****.

LPA requested the following documents to be submitted to CCL by 07/17/26: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) and a current copy of liability insurance in order to update the facility file.

Exit interview was conducted with Administrator, Angela. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mary Garza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/13/2026 09:58 AM - It Cannot Be Edited


Created By: Mary Garza On 07/11/2026 at 05:56 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: VISALIA SENIOR LIVING CARE
FACILITY NUMBER: 547208958

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)
87202 Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county or city and county fire department, or district providing fire protection services, or the State Fire Marshal.
This requirement was not met as evidence by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that the back yard double gate and side gate listed as a fire exit observed locked and inaccessible. Fire door from living room to hallway was observed propped open with a chair. This poses an immediate health safety and or personal rights risk to residents in care. ***Immediate civil penalty assessed in the amount of $500.*****
POC Due Date: 07/13/2026
Plan of Correction
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Administrator immediately had staff unlock gates and closed door. Deficiency cleared during visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mary Garza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2026


LIC809 (FAS) - (06/04)
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