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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206544
Report Date: 12/07/2024
Date Signed: 12/07/2024 06:37:44 PM

Document Has Been Signed on 12/07/2024 06:37 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:REHABILITATION CENTRE OF FRESNOFACILITY NUMBER:
107206544
ADMINISTRATOR/
DIRECTOR:		BAINS, AMANFACILITY TYPE:
740
ADDRESS:1665 M STTELEPHONE:
(559) 268-5361
CITY:FRESNOSTATE: CAZIP CODE:
93721
CAPACITY: 70CENSUS: 51DATE:
12/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:42 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
06:46 PM
NARRATIVE
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On 12/7/24 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived unannounced for an annual inspection visit. LPAs met with Medical Technician, Sumanpreet Kaur, introduced selves, explained reason for visit and were permitted entry into the facility. Administrator, Aman Bains was contacted and stated they were unavailable. LPAs were given permission to start tour. Administrator arrived some time later.

LPAs completed a health and safety check on residents in care. LPAs toured the facility. Residents observed in common areas and in rooms. Pathways and doors were clear and free from obstruction. Facility was clean and without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and fires alarms are on a system and last serviced 11/24/24. Carbon monoxide detector was present and operational at time of visit. Fire extinguisher last serviced 11/14/2024. Last fire drill on 9/27/24. Resident rooms observed to be odor free, clean and with adequate lighting. Linen supplies are kept in linen closets at end of hallways. Sharps, chemicals and medications were located in locked closet. LPA observed sufficient seating under covered patio area on bottom floor.

The following issues were observed during todays visit: Water temperature measured 130.2 degrees F (Rm 511) and 127.9 degrees F (Rm 425) without warning signs. Facility in need of repair in the elevator doorways, hallway walls, ceiling tiles outside of elevator and in hallways, paint in need of touch up on hallway walls and on doors to resident rooms. All resident beds were observed to be hospital beds. Hallway floors throughout the facility are in need of repair/replacement. Elevator making noise and in need of service.

LPA requested the following documents to be submitted to CCL by 12/13/2024: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Exit interview completed with Administrator, Aman. 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: 12/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2024
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 12/07/2024 06:37 PM - It Cannot Be Edited


Created By: Mary Garza On 12/07/2024 at 06:02 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: REHABILITATION CENTRE OF FRESNO
FACILITY NUMBER: 107206544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.695(f)(1)
Other Provisions
(f) A facility shall have both of the following in place: (1) An evacuation chair at each stairwell, on or before July 1, 2019.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that the facility was not observed with evacuation chair at stairways. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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Administrator stated they will purchase chairs for the stairwells. Administrator stated they will provide receipts as proof of correction by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 12/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/07/2024 06:37 PM - It Cannot Be Edited


Created By: Mary Garza On 12/07/2024 at 06:15 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: REHABILITATION CENTRE OF FRESNO
FACILITY NUMBER: 107206544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based LPA observation, the licensee did not comply with the section cited above in that facility is in need of repair in the elevator doorways, hallway walls, ceiling tiles outside of elevator and in hallways, paint in need of touch up on hallway walls and on doors to resident rooms. Hallway floors throughout the facility are in need of repair/replacement. Elevator making noise and in need of service. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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Administrator will provide a written plan of correction. As corrections are being completed pictures will be provided to CCL as proof of correction.
Type B
Section Cited
CCR
87303(e)(2)
87303 Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows:
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degrees F (41 degree C) and not more than 120 degrees F (49 degree C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in Water temperature measured 130.2 degrees F (Rm 511) and 127.9 degrees F (Rm 425) without warning signs. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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Administrator stated they will complete a water temperature log for 2 weeks. Temperatures will be taken twice daily in various locations. Water log will be submitted to CCL by POC date 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: 12/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2024


LIC809 (FAS) - (06/04)
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