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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209343
Report Date: 09/06/2023
Date Signed: 09/06/2023 09:00:50 AM

Document Has Been Signed on 09/06/2023 09:00 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:
09/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Gina Nguyen, AdministratorTIME COMPLETED:
09:10 AM
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On 9/6/23 at 8:02 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a follow up prelicensing inspection. LPA met with Administrator Gina Nguyen.

LPA observed the following corrected:

1. Fire extinguisher observed with new service tag of 7/12/23.
2. Three 5 gallon paint buckets observed removed from garage.
3. Master bedroom observed with sufficient furniture and lighting.
4. Outdoor furniture set up in patio.
5. Facility phone was working.
6. Facility's visitor policy was posted.
7. Facility floor plan sketch revised to show correct layout and details; and facility yard sketch revised for details as required.
8. Exterior fire exit gate latch working.
9. Plumbing/piping openings observed covered and flush with the concrete.
10. Chemicals to be locked in kitchen cabinet next to sink.

All licensing requirements have been met. LPA will notify CAB of prelicensing inspection completion. CAB will finalize application and submit license to Licensee once the application process has been completed.

Exit interview 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: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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