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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206562
Report Date: 12/13/2023
Date Signed: 12/13/2023 12:34:27 PM

Document Has Been Signed on 12/13/2023 12:34 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:GREEN VILLAFACILITY NUMBER:
107206562
ADMINISTRATOR:SANTOS, CARLOSFACILITY TYPE:
740
ADDRESS:1463 W. SIERRATELEPHONE:
(559) 439-5760
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: DATE:
12/13/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Administrator, Carlo and LicenseesTIME COMPLETED:
12:48 PM
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On 12/13/2023 an Office Meeting was held.

Present at the meeting was:
Regional Office Manager, Brenda White
Licensing Program Manager, See Moua
Licensing Program Analyst, Mary Garza
Administrator, Marlene Galvez
Administrator, Delia Galvez
Administrator, Carlo Santos
Direct Care Staff, Maricris "Mari" Magpili
Direct Care Staff, Nicandrosunga Sungh

The purpose of the meeting was to discuss what occurred when the LPA visited the facility on 12/5/2023 to open a complaint. During the meeting, LPM and RM discussed:
- the expectation and professional conduct of the Department’s LPAs
- the reason why complaints are opened under Personal Rights
- how inspections are conducted
Licensees, Administrators, and staff were informed that:
- at no time should LPAs be deny entry
- LPAs can take photos to assist in inspections

Licensees, Administrators, and staff communicated their concerns with the LPA and what happened during LPA’s inspection to the facility and how they felt in their interactions with the LPA. RM, LPM, and LPA communicated that the intent of the Department is to remain professional and to continue to work with all parties.

Exit interview completed. A copy of this report was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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