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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209343
Report Date: 08/02/2023
Date Signed: 08/02/2023 11:16:38 AM

Document Has Been Signed on 08/02/2023 11:16 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:VALLEY CARE HOMEFACILITY NUMBER:
547209343
ADMINISTRATOR:NGUYEN, GINAFACILITY TYPE:
735
ADDRESS:3600 W OAKRIDGE AVETELEPHONE:
(510) 469-3400
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 6CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:Gina Nguyen, AdministratorTIME COMPLETED:
11:30 AM
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On 8/2/23 at 8:17 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Pre-Licensing inspection. LPA met with Administrator (ADM) Gina Nguyen. Facility has five bedrooms and 3.5 bathrooms.

LPA toured inside and outside of facility. No obstructions observed. All bedrooms have sufficient furniture and lighting. Sufficient linen observed. Hot water measured 111.3 degrees F. Smoke and carbon monoxide detectors tested and operational. Facility set at comfortable temperature. Dishware and utensils observed. Sharps will be kept in a locked kitchen drawer. Centrally stored medication observed designated to locked file cabinet in office area. First aid kit observed complete. Emergency lighting observed.

The following will need to be corrected:
1. Fire extinguisher observed last serviced on 7/22/22.
2. Three 5 gallon paint buckets observed accessible in the garage.
3. Master bedroom door was locked and inaccessible.
4. Facility did not have outdoor furniture.
5. Facility phone was not working.
6. Facility's visitor policy was not posted.
7. Facility floor plan sketch to be revised to show correct layout and details; facility yard sketch to be revised for details as required.
8. Exterior fire exit gate latch not working.
9. Plumbing/piping openings observed open/uncovered in two separate walking areas of the backyard.
10. Cabinet where chemicals will be kept has not been completely installed.

Facility to correct all above items before notifying LPA to reschedule a follow up inspection. Comp III was completed with Administrator. Exit interview was conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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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