547209004-3-29-2023-24-AS-MTHO-CPA5L4-20230221190232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 547209004
Report Date: 02/21/2023
Date Signed: 03/29/2023 11:25:50 AM

Document Has Been Signed on 03/29/2023 11:25 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/29/2023 08:06 AM

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

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THIS IS AN AMENDED REPORT.

On 2/21/23 at 2:43 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and met with Administrator (ADM) Jeff Moyer. Due to recent updated CCL guidance via PIN 23-02-ASC, visitor and resident screening was not in effect.

Facility was toured with ADM. Hand sanitizer was readily available to residents and visitors. Residents have single or shared apartments. Resident medication checked. Cleaning and PPE supplies were checked. Staff records were reviewed for good health. Administrator certification is valid.

During today’s inspection, ten out of thirteen residents sampled were found to have disinfectants and/or cleaning solutions such as Comet, Windex, Resolve, Fabuloso in their apartments and one resident was observed with a knife set in a knife block on their kitchenette counter. LPA reviewed the LIC 602 “Physician’s Report” for this resident and observed that resident does not have a diagnosis of dementia, is able to manage their own medications, and can have access to their own hygiene items. A deficiency was not issued for Section 87309(a) which states “Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.” However, facility was advised to review the LIC602A for each resident to determine if having access to items such as cleaning solutions and knives would pose a danger to the resident. If a resident cannot manage their own medications or have access to hygiene items per their physician, having access to other items such as knives or cleaning solutions may also pose a risk unless the physician states otherwise.

The following updated forms are to be submitted within two weeks: LIC500, LIC9020, LIC610E, LIC308

No deficiencies cited during this inspection. Exit interview conducted. A copy of this report was given to Administrator Jeff Moyer, whose signature confirms receipt of this report.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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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Document is an Amendment of Original Document on 03/29/2023 08:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: QUAIL PARK AT SHANNON RANCH	FACILITY NUMBER: 547209004
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87309(a)

Storage Space

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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. Nine out of nine residents sampled during inspection was found with disinfectants and/or cleaning solutions (Comet, Windex, Resolve, Fabuloso) accessible in cabinet under kitchen sink and/or cabinet under bathroom sink; and R11 was observed with a complete knife set in a knife block on kitchenette counter, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	THIS REPORT WAS AMENDED. DEFICIENCY NOT ISSUED. Administrator will submit proof of a written plan outling steps that will be taken to ensure all disinfectants, cleaning solutions, and items that could pose a danger are removed from each resident apartment 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	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC809 (FAS) - (06/04)

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