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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406684
Report Date: 02/27/2025
Date Signed: 02/27/2025 04:31:22 PM

Document Has Been Signed on 02/27/2025 04:31 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:SIERRA VIEW HOMES RESIDENTIAL CAREFACILITY NUMBER:
100406684
ADMINISTRATOR/
DIRECTOR:		PENNER, VIRGINIA B.FACILITY TYPE:
741
ADDRESS:1155 E. SPRINGFIELDTELEPHONE:
(559) 638-9226
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 78CENSUS: 43DATE:
02/27/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Licensed Vocational Nurse (LVN), Cecilia Barraza TIME VISIT/
INSPECTION COMPLETED:
04:38 PM
NARRATIVE
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On 2/27/25 Licensing Program Analyst (LPA) M. Garza completed an unannounced case management visit. LPA met with Cheif Executive Officer (CEO), Roberta "Ro" Linscheid and Licensed Vocational Nurse (LVN), Cecilia Barraza was informed Administrator, Virginia Penner was unavailable. LPA introduced self, explained reason for visit and was permitted entry into the facility. This Case Management is being conducted as follow up for Incident Reports (IR) received by the Department.

1) IR was received by CCL for an incident occurring on 8/31/2024. R1 fell and was sent to Emergency Room. R1 was given a diagnosis of a pelvic fracture. Facility did not report this incident to CCL until 9/14/24. Deficiency cited for late reporting per Title 22.

2) IR received by CCL for incident on 10/26/24. R2 had physical altercation with R3 and R4. PD called to the facility. SOC 341 was completed but not submitted to CCL. Deficiency cited for reporting requirements per Title 22.

3) IR received by CCL for incident occurring on 12/30/24. R5 fell in dining room, hitting their shoulder and falling on wrist. R5 was sent to the hospital and was diagnosed with a fracture to their left wrist. Facility did not provide discharge paperwork showing follow up for R5. During record review of discharge paperwork, R5 returned to the physician on 1/1/25 and 1/10/25 for follow up on this injury. R5 wore brace with no further follow up. No deficiencies cited for this incident.

4) IR received by CCL for incident occurring on 2/11/25. R6 was found outside at 5:15 am. Per S1 there was a freeze warning the night of 2/10/25. Per incident report R6 was found outside memory care unit in the patio area with bleeding to their head. R6 was moving but not responsive to conversation. R6 sent to ER via EMS and treated for low blood pressure, hypothermia and head injury. Additional information need for this case management. LPA will return once gathered. Deficiencies will be issued at that time, if necessary.
CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: SIERRA VIEW HOMES RESIDENTIAL CARE
FACILITY NUMBER: 100406684
VISIT DATE: 02/27/2025
NARRATIVE
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CONT...

5) During annual visit conducted on 2/27/25 R7 was observed with bruising to the left side of the face. R7 stated they fell. Record review of R7's file disclosed incident occurred on 2/22/25. R7 was sent to ER and returned with diagnosis of UTI. No deficiency cited for this incident.

Deficiencies cited per Title 22. Exit interview completed with LVN, Cecilia Barraza. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/27/2025 04:31 PM - It Cannot Be Edited


Created By: Mary Garza On 02/27/2025 at 04:10 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: SIERRA VIEW HOMES RESIDENTIAL CARE
FACILITY NUMBER: 100406684

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2025
Section Cited
CCR
87211(a)

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87211 Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:...
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Per LVN In-Service will be completed on regulation. In-service sign in sheet and training material will be submitted to CCL as proof of correction by POC date.
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This requirement was not met as evidence by: LPA observation of Incident Reports, SOC 341 reports, and resident files. The licensee did not comply with the section cited above in that the facility did not provide a SOC 341 to CCL for incident occurring on 10/26/2024. Facility did not report an incident occurring on 8/31/24 in the required time frame. This poses a potential health, safety and or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2025


LIC809 (FAS) - (06/04)
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