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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209219
Report Date: 07/29/2023
Date Signed: 07/29/2023 01:58:43 PM


Document Has Been Signed on 07/29/2023 01:58 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:KAWEAH HEALTH RUTH WOOD OPEN ARMS HOUSEFACILITY NUMBER:
547209219
ADMINISTRATOR:SALAZAR, DEBORAHFACILITY TYPE:
740
ADDRESS:3234 W. IRIS AVE.TELEPHONE:
(559) 625-0139
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 1DATE:
07/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Deborah Salazar TIME COMPLETED:
02:10 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 7/29/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff Manahill Beig. Administrator Deborah Salazar arrived shortly after.

LPA conducted facility tour with Staff. All pathways, entrances and exits were clear from obstructions. The tour started in kitchen, continued to dining room, living room and resident rooms. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Facility Laundry room is connected to Kitchen. Laundry room observed locked with cleaning supplies and chemicals. Dining room and Living room observed with sufficient seating and activities for residents. Facility has one resident at this time. LPA toured several bedrooms which were observed to be furnished with required furniture and adequate lighting. Bathrooms were properly equipped with non-slip mats and grab bars. Fire extinguisher in hallway was last serviced on 6/5/2023 and was fully charged. Carbon monoxide and smoke alarm detectors installed and operational. Linen supply is kept in the hallway closet. Medications are kept in locked cabinets in the hallway. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that current staff on duty is CPR certified. LPA observed sufficient seating under covered patio area in the back of the facility. Side gate was self-closing and self-latching.

No deficiency observed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 8/4/2023: Current copy. of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020.

An exit interview was conducted with Administrator. Report signed on-site; a copy of this report was provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 07/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2023
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 1