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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204173
Report Date: 07/19/2023
Date Signed: 07/19/2023 09:31:42 AM

Document Has Been Signed on 07/19/2023 09:31 AM - 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:FRESNO GUEST HOMEFACILITY NUMBER:
107204173
ADMINISTRATOR:KUTNERIAN, ANGELICAFACILITY TYPE:
740
ADDRESS:2776 E. MAGILLTELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 5DATE:
07/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Angelica Kutnerian, AdministratorTIME COMPLETED:
09:40 AM
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On 7/19/23 at 8:36 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management - other inspection. LPA explained reason for inspection and was granted entry by staff. Administrator (ADM) Angelica Kutnerian arrived a short time later.

CCL received an incident report and death report for R1.

LPA reviewed records and interviewed ADM.

No deficiencies cited during this inspection.

Exit interview conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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