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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209233
Report Date: 01/09/2025
Date Signed: 01/09/2025 05:51:47 PM

Document Has Been Signed on 01/09/2025 05:51 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/
DIRECTOR:		RODRIGUEZ, LETICIAFACILITY TYPE:
740
ADDRESS:2570 W ALLUVIAL AVENUETELEPHONE:
(559) 400-6700
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 6DATE:
01/09/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:47 PM
MET WITH:Administrator,Phoeun MarezTIME VISIT/
INSPECTION COMPLETED:
06:01 PM
NARRATIVE
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On 1/9/25 Licensing Program Analyst (LPA) M. Garza completed an unannounced case management visit. LPA met with Administrator, Phoeun Marez, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety on residents in care. Residents observed in common area and in rooms.

This case management visit is being completed due to observations made during a complaint visit. The following issues were observed:

Facility does not have the required 2-day perishable and 7-day non-perishable supply of food. Facility was observed with a candle that was previously used. Chemicals/medication and items that pose a danger to residents in care observed in unlocked garage accessible to residents in care.

Deficiencies given per Title 22.

Exit interview completed with Administrator, Phoeun. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/09/2025 05:51 PM - It Cannot Be Edited


Created By: Mary Garza On 01/09/2025 at 05:02 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: LA CASA DELLA NONNA
FACILITY NUMBER: 107209233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2025
Section Cited
CCR
87555(a)

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87555 General Food Service Requirements
(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Administrator stated they will purchase groceries today. Receipt will be provided to CCL by POC date
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This requirement was not met as evidence by: LPA observation of food stored in the facility was not of the quantity for the residents in care. This poses an immediate health, safety and or personal rights risk to residents in care.
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Type A
01/10/2025
Section Cited
CCR87303(h)

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87303 Maintenance and Operation
(h)... Open-flame lights shall not be used.
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Administrator immediately threw away. Administrator stated they will provide training on oxygen use, open flames, fire safety to all staff. In-service sign in sheet 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 candles previously used 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:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/09/2025 05:51 PM - It Cannot Be Edited


Created By: Mary Garza On 01/09/2025 at 05:47 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: LA CASA DELLA NONNA
FACILITY NUMBER: 107209233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
87309(a)

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87309 Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Administrator stated all staff will be trained. In-service sign in sheet and training material will be provided to CCL by POC date.
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This requirement was not met as evidence by: Chemicals, medication and items that pose a danger to residents in care observed in unlocked garage accessible to residents.
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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: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
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