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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209276
Report Date: 12/05/2022
Date Signed: 12/27/2022 01:05:00 PM


Document Has Been Signed on 12/27/2022 01:05 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:DIGNITY SENIOR LIVING HOMEFACILITY NUMBER:
547209276
ADMINISTRATOR:LEONG, EMILYFACILITY TYPE:
740
ADDRESS:3043 S. CEDAR STREETTELEPHONE:
(559) 563-4896
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:6CENSUS: 0DATE:
12/05/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:Administrator, Emily LeongTIME COMPLETED:
02:10 PM
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On 12/5/22 Licensing Program Analyst M. Garza arrived at facility to complete a pre-licensing visit. LPA met with Administrator, Emily Leong. LPA was not COVID pre-screened prior to entry into the facility.

LPA toured facility. Common areas have adequate furnishings and lighting. All resident bedrooms have required furnishings and adequate lighting. Hot water temperature measured at 110 degrees F. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen observed to have dishes, plates, utensils. Cleaning supplies are stored in a locked cabinet under the sink in the kitchen and in a cabinet in the garage. Medications to be stored in a locked cabinet in the kitchen. First aid kit contains all the required items. A fire extinguisher is present but missing receipt for date of purchase. Was purchased 10/1/2022. Smoke detectors and carbon monoxide were operating.

Tour completed outside facility. Exits open free of obstruction. No outside hazards observed. No pools or bodies of water. Facility needs delayed egress. Administrator to purchase/install upon acceptance of dementia resident(s).

Required postings observed with exception of Ombudsman posting. Facility phone number will be (559) 623-9276.

Component III was conducted during pre-licensing visit with Administrator, Emily Leong..

I have found that applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
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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