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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209318
Report Date: 07/07/2023
Date Signed: 07/07/2023 01:59:46 PM

Document Has Been Signed on 07/07/2023 01:59 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:
07/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Keghoughy HandianTIME COMPLETED:
02:09 PM
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On 7/7/2023 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 door to water heater closet fixed. The walkway to the fire exit on the right side of the facility has concrete slope placed. The fence board on the back fence was replaced.

LPA will inform Sacramento the corrections have been made and the facility is ready for license. Component III completed with Keg. 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: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
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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