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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 355202320
Report Date: 09/29/2023
Date Signed: 09/29/2023 01:08:03 PM

Document Has Been Signed on 09/29/2023 01:08 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:BLUE RIVERFACILITY NUMBER:
355202320
ADMINISTRATOR:STEPHANIE SILVAFACILITY TYPE:
735
ADDRESS:245 DAFFODIL DR.TELEPHONE:
(831) 638-1040
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 12CENSUS: 10DATE:
09/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Deane Cook - AdministratrorTIME COMPLETED:
01:20 PM
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On 9/29/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual Inspection. LPA met with Administrator Deane Cook and announced the purpose of the visit. Administrator certificate is current with renewal date 3/19/2024.

During the inspection, LPA toured the facility inside and outside. All exits and passageways were clear and free from instruction. LPA observed smoke detectors and carbon monoxide detectors to be functioning properly, and fire extinguishers were present with inspection date 9/20/2022. LPA reviewed facility emergency disaster plan and records of emergency drills. Medications were secured in a locked cabinet, and medications appeared to be administered properly. Chemicals and cleaning supplies were secured in a locked closet. LPA observed a sufficient supply of perishable and nonperishable foodstuffs which appeared to be stored properly.

Common areas were clean and odor free. LPA toured resident bedrooms and bathrooms. Bedrooms and bathrooms were clean, odor-free, well lit, and contained required minimum furnishings. Bathrooms were clean and odor free, and fixtures were functioning properly. Outdoor area was free from hazards and had enough seating for residents. LPA reviewed staff and resident files.

Licensee agreed to submit a copy of the following forms to CCLD by 10/6/2023: LIC9020, LIC308, LIC309, LIC500, current Administrator's Certificate. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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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