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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209208
Report Date: 12/23/2024
Date Signed: 12/23/2024 12:57:54 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/23/2024 12:57 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:ABLELIGHT, INC. -DEWITTFACILITY NUMBER:
107209208
ADMINISTRATOR/
DIRECTOR:		MASK, ITASKAFACILITY TYPE:
740
ADDRESS:898 N. DEWITT AVE.TELEPHONE:
(559) 322-9183
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 4CENSUS: 4DATE:
12/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:43 AM
MET WITH:Administrator, Itaska MaskTIME VISIT/
INSPECTION COMPLETED:
01:06 PM
NARRATIVE
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On 12/23/24 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Staff, Raijanae Harris, introduced self, explained reason for visit and was permitted entry into the facility. Administrator, Itaska Mask was contacted and arrived a short time later.

LPA completed a health and safety check on residents in care. LPA toured the facility inside and out. 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 clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Some run on a fire system. Fire extinguisher last serviced 03/19/2024. Last fire drill was on 11/20/2024. 2 of 4 resident rooms observed to have the required furnishings. All observed with adequate lighting. Linen supplies are kept in linen closets. Sharps and chemicals were located in locked closets/cabinets. LPA observed sufficient seating under covered patio areas.

The following issues were observed during todays visit: Water temperature measured 94.1 degrees F in bathroom #3. 2 of 4 resident bedroom observed with out chairs. R1 bedroom observed with paint in need of touch up. Medications observed in refrigerator unlocked and accessible. Sample linen observed torn and in need of replacement. Bathroom #2 cabinet under sink in need of repair. Bathroom #3 cabinet door under sink in need of repair. Bathroom #3 observed in need of cleaning in shower area. Gate wire on right side gate in need of repair. Debris along right side fence, back yard fence and in garage in need of removal. Right side of patio observed with moss on concrete in need of cleaning. Holes from neighbors dog in need of filling along right side fence. Wall near dryer vent on left side of yard in need of cleaning. Gate on left side of yard not self-latching. Fence board on left side of yard observed with rot in need of replacement. Spider webs observed in garage in need of cleaning. Meeting point missing on facility sketch. CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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: ABLELIGHT, INC. -DEWITT
FACILITY NUMBER: 107209208
VISIT DATE: 12/23/2024
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CONT...

LPA requested the following documents to be submitted to CCL by 1/3/24: 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) in order to update the facility file.

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

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 12/23/2024 12:57 PM - It Cannot Be Edited


Created By: Mary Garza On 12/23/2024 at 11:30 AM
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. -DEWITT
FACILITY NUMBER: 107209208

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
87303(a)

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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.
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Administraor stated maintenance will be contacted to address issues. Administrator stated they will do additional facility checks for any arrising issues. Administrator stated pictures will be sent to CCL by POC date as proof of correction.
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This requirement was not met as evidence by LPA observation of: R1 bedroom observed with paint in need of touch up. Bathroom #2 cabinet under sink in need of repair. Bathroom #3 cabinet door under sink in need of repair. Bathroom #3 observed in need of cleaning in shower area. Gate to right side gate in need of repair. Debris along right side fence, back yard fence and in garage in need of removal. Right side of patio observed with moss on concrete in need of cleaning. Holes from neighbors’ dog in need of filling along left side fence. Wall near dryer vent on left side of yard in need of cleaning. Gate on left side of yard not self-latching. Fence board on left side of yard observed with rot in need of replacement. This poses a potential health, safety and or personal rights risk to residents in care.
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Type B
01/03/2025
Section Cited
CCR87303(e)(2)

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87303 Furniture, Fixtures, Equipment, and Supplies (e) Water supplies and plumbing fixtures shall be maintained as follows: (2)Faucets used by residents...shall deliver hot water. Hot water temperature ... to attain a temperature of not less than 105 degrees F (41 degree C) and not more than 120 degrees F (49 degree C).
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Administrator stated maintenance will be called out to check the water temperature. Water temperature log will be completed for 2 weeks, in diffrent locations at diffrent time of the day. Log will be sent to CCL by POC date as proof of correction.
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This requirement was not met as evidence by LPA observation of: Water temperature measured at 94.1 degrees F in bathroom #3. This poses a potential health, safety and or personal rights risk to residents in care.
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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: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/23/2024 12:57 PM - It Cannot Be Edited


Created By: Mary Garza On 12/23/2024 at 12:30 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. -DEWITT
FACILITY NUMBER: 107209208

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
87465(h)(2)

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87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
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Administrator stated they will be moved out of the refrigerator and placed into the med station. They will remain locked and inaccessible. Picture will be sent to show they were removed and place in med station. In-service will be completed with all staff. In-serivce sign in sheets and training material will be provided to CCL by POC date.
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This requirement was not met as evidence by LPA observation of: medication (prescribed supplements) in the refrigerator unlocked and accessible to residents in care. This poses a potential health, safety and or personal rights risk to residents in care.
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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: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2024


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