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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400070
Report Date: 07/17/2023
Date Signed: 07/17/2023 03:31:24 PM

Document Has Been Signed on 07/17/2023 03:31 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:CALIFORNIA ARMENIAN HOMEFACILITY NUMBER:
100400070
ADMINISTRATOR:PAUL ROCHAFACILITY TYPE:
741
ADDRESS:6720 E KINGS CANYON RDTELEPHONE:
(559) 251-8414
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 392CENSUS: 117DATE:
07/17/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:Ashley Mendoza, Memory Care Director TIME COMPLETED:
03:30 PM
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On 07/17/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct case management visit for the purpose of checking on the health and safety of the residents in care. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Yvette Abrahamian in front desk who stated Administrator is unavailable. Ashley Mendoza, Memory Care Director was called and arrived shortly.

LPA tour Resident 1 (R1) room and facility with MCD. LPA conducted interview, obtain copies of records, and copies of R1’s file.

No deficiencies cited during today's inspection.

Exit interview conducted. A copy of this report was provided to MCD, whose signature on this form confirms
receipt of these report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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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