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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406684
Report Date: 03/06/2025
Date Signed: 03/06/2025 06:24:53 PM

Document Has Been Signed on 03/06/2025 06:24 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: 41DATE:
03/06/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:09 AM
MET WITH:Administrator, Jenny PennerTIME VISIT/
INSPECTION COMPLETED:
05:52 PM
NARRATIVE
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On 3/6/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced annual continuation visit. LPA met with Administrator, Jenny Penner, explained reason for visit and was permitted entry into the facility. LPA observed residents in common areas.

Annual continuation visit is being conducted to complete items from previous visit on 2/27/2025. Visit was a continuation for resident records review, hospice care plans, staff file reviews, incidental medical/dental, medications and a completion of the care tool.

The following issues were observed during todays visit: Residents with health conditions do not have the required exceptions/care plans in place. 5 of 5 resident files were not observed with the required pre-admission appraisal/reappraisals. Deficiencies cited per Title 22.

Exit interview completed with Administrator, Jenny. A copy of this report, deficiencies, TV's and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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Document Has Been Signed on 03/06/2025 06:24 PM - It Cannot Be Edited


Created By: Mary Garza On 03/06/2025 at 05:32 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: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87463(a)
Reappraisals
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 5 of 5 files reviewed did not have appraisals as required. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2025
Plan of Correction
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Administrator will review regulations and train management staff to update appraisals. In-service sign in sheet and training material will be sent to CCL by POC date as proof of correction.
Type B
Section Cited
CCR
87616(b)
Exceptions for Health Conditions
(b) Written requests shall include, but are not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in resident files reviewed showing residents with health conditions do not have the required exceptions/care plans in place. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2025
Plan of Correction
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Administrator stated they will generate a template to use for exceptions and submit to CCL for review by POC date. Training will be completed with Medical Technicians and Licensed Vocational Nurse and Registered Nurse on exceptions and care plans. A copy of in-service sign in sheet and training material will be submitted as proof of correction.
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: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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