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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209318
Report Date: 05/24/2023
Date Signed: 07/13/2023 05:25:03 PM

Document Has Been Signed on 07/13/2023 05:25 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:SEQUOIA GROVE ASSISTED LIVING INCFACILITY NUMBER:
107209318
ADMINISTRATOR:HANDIAN, KEGHOUGHYFACILITY TYPE:
740
ADDRESS:1567 W MAGILL AVETELEPHONE:
(559) 449-1249
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 0DATE:
05/24/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Keghoughy "Keg" Handian TIME COMPLETED:
03:30 PM
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On 5/24/2023 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete a pre-licensing visit. LPA met with Licensee, Keghoughy "keg" Handian, explained reason for visit and was permitted entry into the facility. LPA toured facility inside and out.

Tour of facility completed. Resident’s furnishings, personal hygiene, grooming products, dishes and utensils were observed. Common areas have required furnishings and adequate lighting. 4 of 5 rooms will be private. Rooms equipped with mobile call buttons. 6 of 6 resident beds observed without box springs. Bathrooms were properly equipped with grab bars, non-slip mats, paper towels and hand washing signs. Trash cans have tight fitting lids. Hot water temperature measured at 105 degrees F. Sharps/knives are locked in the kitchen and medications are locked in a cabinet located in the office area. Cleaning supplies are stored in a locked cabinet in the laundry room. Fire extinguisher is present and was serviced April 17, 2023. Smoke detectors and carbon monoxide were present and operational at time of visit. Auditory alarms observed on all exterior doors and windows. Required postings are observed. Let-Us-Know posting not the required size.

Facility toured outside. Exits and walkways free of obstruction. Gate on side of facility was not self-latching. Left corner area of yard is currently storage for cut wood. Area surrounded by polycarbonate corrugated roofing panels made into a fencing area approximately 3 feet high. No gate/lock present into area. The left side of the facility has debris stored against the house. Garage door from living to garage secured but has previous owners’ belongings inside.



Due to corrections needing to be made the Pre-Licensing was not complete and the Component III was not completed. No deficiencies cited during todays visit.

Exit interview completed with Licensee and a copy of this report was given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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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