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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209233
Report Date: 04/12/2024
Date Signed: 09/12/2024 09:11:19 AM

Document Has Been Signed on 09/12/2024 09:11 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:LA CASA DELLA NONNAFACILITY NUMBER:
107209233
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, LETICIAFACILITY TYPE:
740
ADDRESS:2570 W ALLUVIAL AVENUETELEPHONE:
(559) 400-6700
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 5DATE:
04/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Admnistrator, Leticia RodriguezTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 4/12/24 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 5 residents are residing in the facility and receiving care. No residents with dementia currently residing at the facility. Facility does not have any residents receiving hospice services. 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:
1) Outside walkways observed to be a tripping hazard and having a 2-4 inch drop to level ground and a brick missing. Walkway tripping hazards have been filled in with landscaping rocks.
2) Right side fence has 2 boards loose that need to be nailed in and leaning to neighbors yard. Fence boards were nailed in and fence is no longer leaning.
3) Water temperature in master bedroom measured at 124.2 degrees F. Water temperature measured at 123.9 during todays visit. Bathroom #1 measured at 116.9 degrees F.

Water temperature was lowered at the water heater. A temperature regulator was ordered and pending delivery. Temperature readings will be taken twice daily in 2 separate bathrooms for the next 2 weeks. Temperature log will be sent to CCL no later than 4/29/24. All other corrections have been made.

The Component III conducted with Administrator. LPA will send notification facility is ready to be licensed. Exit interview completed with Licensee, Nina Kunzler and Administrator, Leticia Rodriguez. A copy of this report was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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