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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209318
Report Date: 06/19/2023
Date Signed: 06/19/2023 03:09:52 PM

Document Has Been Signed on 06/19/2023 03:09 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:
06/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Licensee, Keghoughy "Keg" HandianTIME COMPLETED:
03:23 PM
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On 6/19/2023 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.

Purpose of visit was to observe previous issues needing to be corrected in an effort to be pre-licensed. During visit LPA observed gate to the right side of the facility was self-latching. Left corner area of yard had wood and paneling removed. Left side gate unlocked and self latching. Left side of the facility has debris removed. Garage had previous owners’ belongings removed.

During tour LPA observed door to waterheater closet with a whole in the bottom left and covered by a brick. The walkway to the fire exit on the right side of the facility has concrete with a 1-2 inch lip causing a tripping hazard. A fence board on the back fence was splintered and in need of replacement. All posing a potential health and safety risk.

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: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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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