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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209267
Report Date: 12/06/2022
Date Signed: 12/06/2022 10:34:52 AM

Document Has Been Signed on 12/06/2022 10:34 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:HOME IS WHY LLCFACILITY NUMBER:
107209267
ADMINISTRATOR:TEASLEY, DEANGELAFACILITY TYPE:
740
ADDRESS:5364 E. MCKENZIETELEPHONE:
(334) 652-9491
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 0DATE:
12/06/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Deangela TeasleyTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) K.Kaur conducted a Pre-licensing Inspection on this date. LPA met with Administrator Deangela Teasley. A tour of the facility was conducted together.

The facility was observed to be at a comfortable temperature, clean, in good repair. No passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. The dining room is equipped with a table and chairs, living room is equipped with adequate sofas and seating for residents. Adequate outside space for rest and recreational and a covered patio was observed.

Extra linen and towels are available. Hot water temperature measured at 118 degrees F. Carbon monoxide
and smoke alarm detectors installed and operational. Grab bars installed in showers and by toilets, non-skid
mats in place, hand soap and paper towels available for use. Trash cans with tight fitting lids are in place.

Perishable and non-perishable food supply appeared adequate. Knives will be locked in a container in the kitchen cabinet. Cleaning and chemical supplies are kept in in garage in a locked cabinet. Residents' bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting. Mattresses and linen were in good condition.

Fire extinguisher was serviced on 03/27/2022 and fully charged. Medication and first aid kit are locked in the
Hallway closet. Complaint poster posted, resident council info posted, residents' rights posted, emergency
disaster plan posted. Gate is self-closing and self-latching.

Component III was also conducted and completed. Exit interview was conducted. Pre-licensing requirements
were met. An exit interview was conducted with Administrator. Report signed on-site by Administrator; a copy of report was provided by email.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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