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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209233
Report Date: 03/28/2024
Date Signed: 04/12/2024 12:11:00 PM

Document Has Been Signed on 04/12/2024 12:11 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:LA CASA DELLA NONNAFACILITY NUMBER:
107209233
ADMINISTRATOR:RODRIGUEZ, LETICIAFACILITY TYPE:
740
ADDRESS:2570 W ALLUVIAL AVENUETELEPHONE:
(559) 400-6700
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 6DATE:
03/28/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Administrator, Leticia RodriguezTIME COMPLETED:
02:27 PM
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On 3/28/24 Licensing Program Analyst (LPA) M. Garza arrived for an announced pre-licensing inspection visit. LPA was met by Administrator, Leticia Rodriguez and was permitted entry into the facility.

Facility is in the process of pre-licensing. Currently 6 residents are residing in the facility and receiving care. 1 resident with dementia currently residing at the facility. Facility has 1 resident currently receiving hospice services and 1 resident receiving home health services. LPA completed a health and safety check on residents in care. Residents observed in common area watching television and in rooms.

Tour of facility inside and out was completed to follow up on the following issues: 2 of 4 bedrooms observed without box springs. 1 of 4 resident bedrooms observed with a shared dresser. Water temperature measured at 131.2 degrees F and in need of warning signs. Outside walkways observed to be a tripping hazard and having a 2-4 inch drop to level ground. Water accumulating around/in planters and in need of correction.

Box springs were purchased and placed on residents beds. Residents with shared dresser each have their own currently. Water accumulating around/in planters, have rocks and plants placed inside as correction.

The following issues were observed during todays visit. Outside walkways observed to be a tripping hazard and having a 2-4 inch drop to level ground and a brick missing. Right side fence has 2 boards loose that need to be nailed in and leaning to neighbors yard. Water temperature in master bedroom measured at 124.2 degrees F.

The Component III was not conducted during this pre-licensing visit due to corrections to facility needing to be completed. This pre-licensing visit was re-schedule for a re-inspection on 4/12/24 at 1pm. Administrator was informed that if at this time the facility is not ready to be licensed civil penalties will begin. At this time the facility is not ready to be licensed. Exit interview completed with Administrator, Leticia Rodriguez. A copy of this report was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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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