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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209201
Report Date: 11/21/2024
Date Signed: 12/02/2024 08:18:02 AM

Document Has Been Signed on 12/02/2024 08:18 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:ABLELIGHT, INC. -ROGERSFACILITY NUMBER:
107209201
ADMINISTRATOR/
DIRECTOR:		MASK, ITASKAFACILITY TYPE:
740
ADDRESS:861 N ROGERS AVENUETELEPHONE:
(559) 323-7295
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 4CENSUS: 4DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:57 AM
MET WITH:Administrator, Itaska MaskTIME VISIT/
INSPECTION COMPLETED:
04:13 PM
NARRATIVE
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On 11/21/24 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Direct Support Professional, Vanndy Nhey, explained reason for visit and was permitted entry into the facility. Administrator, Itaska Mask was contacted and arrived a short time later. LPA completed tour of the facility inside and out. Residents not present at time of visit.

Pathways and doors were clear and free from obstruction. Facility was clean and without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 03/19/2024. Last fire drill on 11/12/2024. Water temperature measured 112.4 degrees F in resident bathroom #2. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. LPA observed sufficient seating under covered patio areas.

The following issues were observed during time of visit: Staff restroom missing hand washing sign. Chemicals observed in staff restroom unlocked and accessible. Scissors observed on counter top of medical station. 4 of 4 residents bedrooms observed without box springs. Kitchen drawer with sharps observed unlocked and accessible. Chemical/items posing a hazard to residents in care observed in hallway closet unlocked and accessible. Bedroom #3 exit door broken and in need of repair to bottom of door. Touch up paint needed around thermostat. Right side gate latch in need of repair/replacement (gate does not latch). Concrete lifted at back corner of house (potential tripping hazard). Fence boards on right and left side of facility in need of fixing/replacement. Debris on left side walkway in need of removal. CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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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: ABLELIGHT, INC. -ROGERS
FACILITY NUMBER: 107209201
VISIT DATE: 11/21/2024
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CONT...

LPA requested the following documents to be submitted to CCL by 12/02/2024: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), copy of liability insurance in order to update the facility file.

Exit interview completed with Administrator, Itaska Mask. A copy of this report, deficiency, TV's and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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Document Has Been Signed on 12/02/2024 08:18 AM - It Cannot Be Edited


Created By: Mary Garza On 11/21/2024 at 03:38 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: ABLELIGHT, INC. -ROGERS
FACILITY NUMBER: 107209201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(a)
Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

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 chemicals observed in staff restroom unlocked and accessible. Scissors observed on counter top of medical station unlocked and accessible. Kitchen drawer with sharps observed unlocked and accessible. Chemical/items posing a hazard to residents in care observed in hallway closet unlocked and accessible. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2024
Plan of Correction
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Administrator stated that all staff training will be completed with staff. In-service sign in sheet and training material will be provided to CCL by POC date as proof of corrections. Observation log will be provided to CCL as proof of random checks.
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: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2024


LIC809 (FAS) - (06/04)
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