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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209086
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:04:59 PM

Document Has Been Signed on 02/27/2024 03:04 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:BK HOUSE OF GRACE LLCFACILITY NUMBER:
107209086
ADMINISTRATOR:RIEMER, ROSEMARIE HFACILITY TYPE:
740
ADDRESS:1463 N ARCHIE AVENUETELEPHONE:
(559) 201-8329
CITY:FRESNOSTATE: CAZIP CODE:
93703
CAPACITY: 6CENSUS: 5DATE:
02/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Rosemarie Riemer/ Licensee Balwinder KaurTIME COMPLETED:
03:20 PM
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On 2/27/2024, Licensing Program Analyst (LPA) K.Kaur arrived unannounced for complaint inspection and conducted a case management in conjunction. LPA was allowed entry by Administrator Rosemarie Riemer. Licensee Balwinder Kaur was also available at the facility.

LPA observed on a pervious visit on 11/15/2023 staff member Leonardo Yap (S1) and his Spouse (S2) at the facility. Spouse is not finger cleared and is not associated with the facility.

Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. An Immediate civil penalty of $100 assessed for Caregiver Background Check.

An exit interview was conducted with Licensee discussing the plan of corrections. Report signed on-site; printed copy provided with 809D page and appeal rights.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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 02/27/2024 03:04 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 02/27/2024 at 01:57 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: BK HOUSE OF GRACE LLC
FACILITY NUMBER: 107209086

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2024
Section Cited
CCR
80019(e)(2)

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or...

This requirement is not met as evidenced by:
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S2 may not return to the facility until finger printed and assoicated with the facility.
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Based on interview and record review, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. Staff 1’s Spouse (S2) does not have fingerprint clearance and was observed at the facility.
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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:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
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