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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107207121
Report Date: 05/03/2023
Date Signed: 05/03/2023 02:29:41 PM

Document Has Been Signed on 05/03/2023 02:29 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:NINA'S HOMEFACILITY NUMBER:
107207121
ADMINISTRATOR:RODRIGUEZ, LETICIAFACILITY TYPE:
740
ADDRESS:6540 N. BRIARWOODTELEPHONE:
(559) 253-3024
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: DATE:
05/03/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Leticia RodriguezTIME COMPLETED:
02:30 PM
NARRATIVE
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An Informal Meeting was conducted on this date at the RO Office. Present were:

CCL Staff: LPM (Licensing Program Manager) Sergiy Pidgirny, LPM See Moua, LPA (Licensing Program Analyst) Mary Garza and Facility Staff: Licensee, Yanina Garcia via telephone and
Administrator, Leticia Rodriguez.

The purpose of the office meeting is to discuss concerns regarding the licensee’s Unlicensed Operations. Since 2014, the Department has received 17 Unlicensed complaints to homes operated by the licensee. The unlicensed homes are:

1. 2570 W. Alluvial Ave, Fresno 93711; complaint was received 2/1/22

2. 2635 W. Bullard Ave, Fresno, 93711; complaint was received 1/13/14, received 4/25/16, received 8/11/16, received 11/7/17, received 3/13/18, received 9/18/18, received 2/12/21

3. 5375 N. Forkner Ave, Fresno, 93711; received 5/22/17, received 9/18/18, received 11/1/19, received 8/20/20, received 2/10/23

4. 2649 W. San Jose Ave, Fresno 93711; received 9/18/18, received 6/14/19



CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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: NINA'S HOME
FACILITY NUMBER: 107207121
VISIT DATE: 05/03/2023
NARRATIVE
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CONT...

5. 2787 W. Robinwood Lane, Fresno 93711
- received 2/7/22

6. 5363 W. Roberts Ave, Fresno 93722
- received 4/17/23

During the meeting discussions of concerns and operations of Unlicensed facilities on commercials, advertisements and websites. Meeting covered the numerous complaints regarding these as a Licensee. Current room and boards advertised as independent living (6) facilities ran by the Licensee. Per Licensee they are providing meals only in the unlicensed homes. Licensees understanding of Independent residents/clients are defined as they can feed, shower and do everything on their own. Per Licensee, if the residents/clients have IHSS, care givers or hire someone.

Licensee was informed that at this time it appears the independent living and assisted living falls under a license associated with Nina's Home Care Inc.

Licensee stated it is their intention to both open and convert new RCFE's. Licensee was informed that operations can effect any future ventures for licensing. Enforcement laws and regulation for licensed facilities were covered.

Licensee agreed to delete website and update future advertisements and keep them separate and to re-evaluate residents/clients to see if they require care and supervision.

Deficiencies cited during todays visit. See attached 809D.

Exit interview completed with Administrator, Leticia Rodriguez. A copy of this report given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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Document Has Been Signed on 05/03/2023 02:29 PM - It Cannot Be Edited


Created By: Mary Garza On 05/03/2023 at 02:03 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: NINA'S HOME
FACILITY NUMBER: 107207121

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2023
Section Cited
HSC
1569.681(a)

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1569.681 License number; use in advertisements, publications or announcements (a) Each residential care facility for the elderly licensed under this chapter shall reveal its license number in all advertisements, publications, or announcements made with the intent to attract clients or residents.
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Licensee and Administrator agrees to remove advertisements, publications or announcements that advertises the licensed facility without the license number. Licensee will submit the corrected publications a sample as POC by POC date.
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This requirement was not met as evidence by: based off of interviews conducted it was found that Licensee is advertisements, publications or announcements for the elderly licensed facility without the license number.
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Type B
05/17/2023
Section Cited
HSC1569.46

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1569.46 Operation of unlicensed facility as unfair competition and unfair business practice

Operation of an unlicensed facility shall be an act of unfair competition and an unfair business practice within the meaning of Chapter 5 (commencing with Section 17200) of the Business and Professions Code.
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Licensee and Administrator agrees to re-evaluate individuals living in unlicensed room and boards to meet the criteria of independent living.
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This requirement was not met as evidence by: based off of interviews conducted it was found that Licensee is running unlicensed homes and providing care and supervision to residents/clients.
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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: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


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