547209463-2-26-2026-24-AS-MYAG-DRP2BS-20260226161537

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 547209463
Report Date: 02/26/2026
Date Signed: 02/26/2026 04:15:53 PM

Document Has Been Signed on 02/26/2026 04:15 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:	VILLAGE AT MILL CREEK		FACILITY NUMBER:	547209463
ADMINISTRATOR/ DIRECTOR:	BADOUD, ANDREW		FACILITY TYPE:	740
ADDRESS:	2948 & 2950 E DOUGLAS AVE		TELEPHONE:	(559) 625-6001
CITY:	VISALIA	STATE: CA	ZIP CODE:	93292
CAPACITY: 59		CENSUS: 18	DATE:	02/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:55 AM
MET WITH:	Interim Administrator Gus Chavez		TIME VISIT/ INSPECTION COMPLETED:	04:30 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 02/26/26, Licensing Program Analyst (LPA) M. Yang arrived at the facility unannounced to conduct the Annual Inspection. LPA met Interim Administrator (A1) Gustovo “Gus” Chavez and staff (S1) Melissa Segura. LPA conduct tour of facility building A, building B, and building C with A1 and S1. There were 17 residents present during inspection. A sample of staff files was reviewed. The facility was observed to be at a comfortable temperature, clean, and no passageway obstructions or fire hazards. Facility consists of Assisted Living (AL) and Memory Care (MC) Unit. -2950 Building A (Bldg A) – facility label as North Creek with all 18 residents resides as building. -2950 Building B (Bldg B) – facility label as East Creek currently consists with no residents. -2948 Building C (Bldg C) – facility label as South Creek currently consists with no residents. At this time, Bldg B is in the process of finalizing updates and is currently not ready for placement of residents. Multiple topics in relation to operation of Residential Care Facility for the Elderly (RCFE), & the Department's expectation regarding specific regulations were discussed with A1. A1 have agreed to notify the department when final finishing touches have been completed on Bldg B, & ready for Department walk-through prior to placement of residents in Bldg B. Bldg B, all bathrooms’ hot water temperature was tested maintained within range. Kitchen was toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in walk-in freezer, walk-in refrigerator, pantry. Walk-in refrigerator temperature maintained at 40 degree F. All food are prepared in Bldg B and delivered to Bldg A and Bldg C. LPA observed exits in Bldg B to have a 30-second delay egress. Bldg C was toured and currently has no residents reside in building. Side exits clear of debris.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

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: VILLAGE AT MILL CREEK	FACILITY NUMBER: 547209463
	VISIT DATE: 02/26/2026

NARRATIVE

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LPA, A1, and S1 continue to Bldg A. A sample of resident bedrooms was toured. Residents were observed seating in common areas. Facility has sufficient furnishings inside and outside for resident use. Facility is equipped with pull stations and fire sprinklers throughout facility in all three buildings. Fire extinguisher was observed throughout the facility in all three buildings with a service date of: 11/14/25. Carbon monoxide was observed operational and functional during visit. Chemicals were observed locked under sink in kitchen room. Medications were observed locked in medication carts. Hot water temperature tested maintained at 129.7 degree F in bedroom 106, 135.7 degree F in bedroom 109, 111.1 degree F in bedroom 124B, and 116 degree F in bedroom 116B. LPA observed securely fastened grab bars and non-skid mats in showers.

The outside was toured and observed to be free from debris with outdoor seating available for residents. A sample of resident was reviewed.

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

Exit interview was conducted. The following documents are requested and submitted to Fresno CCL by: 03/04/26. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, current liability insurance, and Administrator certificate. A copy of this report and appeal rights was provided to Executive Director.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 02/26/2026 04:15 PM - It Cannot Be Edited

Created By: Mai Yang On 02/26/2026 at 03:34 PM

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: VILLAGE AT MILL CREEK	FACILITY NUMBER: 547209463
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87411(c)(1)

87411(c)(1) Staff providing care shall receive appropriate training in first aid… This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview conducted and records reviewed, A1, S1 and S2 did not have current First Aid certification on file, this poses a potential health and safety risk for the residents in care.
	POC Due Date: 03/04/2026
	Plan of Correction
1 2 3 4	Executive Director state will have A1, S1, and S2 complete current First Aid and submit proof First Aid certification to the Fresno CCL by 03/04/26.

Type B

Section Cited

CCR

87633(b)

87633(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident… This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above when LPA reviewed R1 and R2’s whose currently receiving hospice care with no current hospice care plan on file, which poses a potential health or personal rights risk to persons in care
	POC Due Date: 03/06/2026
	Plan of Correction
1 2 3 4	Executive Director state will obtain R1 and R2’s current hospice care plan and submit it to Fresno CCL by POC due date 03/06/26.

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: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/26/2026 04:15 PM - It Cannot Be Edited

Created By: Mai Yang On 02/26/2026 at 03:41 PM

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: VILLAGE AT MILL CREEK	FACILITY NUMBER: 547209463
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87608(a)(5)(B)

87608(a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and records reviewed, R1, R2, and R3 is receiving hospice care and using a hospital bed with full rail with no doctor’s order, which poses/posed a potential health and safety and personal rights risk to the resident in care.
	POC Due Date: 03/06/2026
	Plan of Correction
1 2 3 4	Executive Director state will obtain doctor orders for R1, R2, and R3 who’s currently receiving hospice care that specific the need for full bed rails by POC due date. If full bed rail is not indicated by physician that is needed, full bed rail is to be removed by POC due date 03/06/26.

Type B

Section Cited

CCR

87506(b)(17)

87506 (b)(17) Each resident’s record shall contain at least the following information: (17) Documents and information required… This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records reviewed and interview conducted, R1, R2, R3, and R4 do not have the required documents on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/18/2026
	Plan of Correction
1 2 3 4	Executive Director state will obtain Lic 601 for R1, R2, and R3. Pre-appraisal and Needs and services plan will be obtained for R1 and R3. Medical Consent Form (Lic 627C) will be obtained for R1, R2, R3, and R4. TB results will be obtained for R3. Obtained records will be submitted to Fresno CCL by POC due date 03/18/26.

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: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 02/26/2026 04:15 PM - It Cannot Be Edited

Created By: Mai Yang On 02/26/2026 at 03:42 PM

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: VILLAGE AT MILL CREEK	FACILITY NUMBER: 547209463
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(e)(2)

87303 (e)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, Hot water temperature was tested observed maintained at 129.7 degree F in bedroom 106 and 135.7 degree F in bedroom 109, which poses/posed a potential health and safety risk to the residents in care.
	POC Due Date: 03/06/2026
	Plan of Correction
1 2 3 4	The facility shall maintain all hot water temperature between 105 degree F and 120 degree F. The facility shall have a daily temperature log to ensure water temperature meets the regulation requirements. Daily temperature log of proof of hot water temperature is tested maintained between 105 degree F and 120 degree F shall be submitted to the department by 03/06/26.

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: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC809 (FAS) - (06/04)

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