547209224-7-10-2026-24-AS-MYAG-DVUMV5-20260710095610

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 547209224
Report Date: 07/10/2026
Date Signed: 07/10/2026 09:57:04 AM

Document Has Been Signed on 07/10/2026 09:57 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:	AUGDON SENIOR CARE HOME #3		FACILITY NUMBER:	547209224
ADMINISTRATOR/ DIRECTOR:	AUGDON, FRANCES		FACILITY TYPE:	740
ADDRESS:	216 ALBERT AVENUE		TELEPHONE:	(559) 592-1875
CITY:	EXETER	STATE: CA	ZIP CODE:	93221
CAPACITY: 4		CENSUS: 2	DATE:	07/10/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:10 AM
MET WITH:	Whitney Hatton, House Manager		TIME VISIT/ INSPECTION COMPLETED:	10:10 AM

NARRATIVE

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On 07/10/26, Licensing Program Analysts (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. LPA met with House manager (S1) Whitney Hatton. LPA was informed by S1 that Licensee/Administrator Frances Augdon Assistant was unavailable to attending meeting. Administrator Renee Arreguin was called arrived shortly and left during visit unable to stay for meeting. LPA toured facility with S1. All two residents were present during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Medications observed kept locked in kitchen shelf. Fire extinguishers were observed with a service date 02/5/26. Last fire drill was completed on 05/30/26. LPA observed 2 day supplies of perishable and 7 day supplies of non-perishable food.

Cleaning supplies observed stored and locked under kitchen sink and in laundry shelves. All bedrooms were observed to have required furnishings and with adequate lighting. Bedroom 2 door observed in disrepair and hole was observed in the lower wall in bedroom 2. Bathroom was toured. LPA observed with securely fastened grab bars and non-skid mats. Hot water temperature was tested at 114 degrees F in bathroom 3, 115.2 degree F in bathroom 2, and 113.5 degree F in bathroom 1. Extra linens and towels observed in hall closet.

(Continued to Lic 809C)

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026

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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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: AUGDON SENIOR CARE HOME #3	FACILITY NUMBER: 547209224
	VISIT DATE: 07/10/2026

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(continued from Lic 809)

Outside of facility toured and observed to be free of debris with adequate outdoor seating available for residents. Carbon monoxide and smoke detectors were tested and observed to be operational. All residents and sample of staff files were reviewed to have all required documents.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6 see attached 809D.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 07/16/26. Forms requested: Lic 308, Lic 500, Lic 610E, current liability insurance, and current Administrator certificate. A copy of this report was provided to the House Manager, whose signature on this form confirms receipt of this report.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/10/2026 09:57 AM - It Cannot Be Edited

Created By: Mai Yang On 07/10/2026 at 09:38 AM

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: AUGDON SENIOR CARE HOME #3	FACILITY NUMBER: 547209224
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

87303 (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, open hole was observed on the lower wall in bedroom 2 and bedroom 2 observed with an open hole, poses/posed a potential health and safety and personal rights risk to the resident in care.
	POC Due Date: 07/16/2026
	Plan of Correction
1 2 3 4	Bedroom 2 door and wall shall be in good repair by POC due date. Proof of repair will be submitted to the Fresno CCL by POC due date 07/16/26.

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.

	See Moua
NAME OF LICENSING PROGRAM MANAGER:

	Mai Yang
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026

LIC809 (FAS) - (06/04)

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