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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209134
Report Date: 03/22/2023
Date Signed: 03/22/2023 01:57:42 PM

Document Has Been Signed on 03/22/2023 01:57 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:DEENA'S CARE HOMEFACILITY NUMBER:
547209134
ADMINISTRATOR:PATCH, DEENAFACILITY TYPE:
735
ADDRESS:3537 W. CUTLER AVE.TELEPHONE:
(559) 679-4609
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: 4DATE:
03/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Care Staff Misty BaileyTIME COMPLETED:
02:15 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 3/22/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA was allowed entry by care staff Misty Bailey. Licensee Deena Patch was contacted but was unavailable to come to the facility to assist with inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway
obstructions or fire hazards were observed. Hand sanitizer was readily available to residents and visitors. Hand washing and other various Covid-19 related signs were observed in the common areas. Sharp items and medications are locked in the kitchen cabinet. Cleaning supplies were locked under the kitchen sink. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in the kitchen was last serviced on 10/26/2022 and was fully charged. Trash cans observed with lids. Common areas were properly furnished and well-lit throughout.

LPA toured 3 private bedrooms with adequate furnishings and 2 restrooms observed to be clean, odor free and functioning at time of visit. Hand washing posters were observed in the bathrooms by the sink. Additional cleaning supplies and laundry detergent locked in garage. Hallway closet observed to have additional bedding, linens, and hygiene products. Backyard observed to have covered patio with sufficient seating. Backyard gate was self-latching and self-closing. A sample of medication was reviewed. Resident records were reviewed for updated emergency contact information and for all necessary documentation. Staff records were unable to be reviewed since they are locked, and Licensee has the only key. LPA will conduct a separate visit to review staff documentation at a later date.

No deficiencies issued during this inspection.

Continued to next page
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
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 2
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: DEENA'S CARE HOME
FACILITY NUMBER: 547209134
VISIT DATE: 03/22/2023
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
26
27
28
29
30
31
32
LPA is requesting the following documents be submitted to the Fresno CCL office by 3/29/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization
(LIC309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan
(LIC610E), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with staff. Report signed on-site; and a printed copy was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2