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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209331
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:09:25 PM

Document Has Been Signed on 06/11/2024 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:ASPIRING CARE FACILITY, INCFACILITY NUMBER:
107209331
ADMINISTRATOR/
DIRECTOR:
VOSKANYAN, MARINEFACILITY TYPE:
740
ADDRESS:3251 WEST ELLARY AVETELEPHONE:
(559) 241-9332
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 1DATE:
06/11/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:31 AM
MET WITH:Administrator, Marine VoskanyanTIME VISIT/
INSPECTION COMPLETED:
01:38 PM
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On 6/11/24 Licensing Program Analyst (LPA) M. Garza conducted an unannounced Post-Licensing inspection. LPA met with Administrator, Marine Voskanyan.

LPA completed tour of the facility inside and out including the kitchen, bedrooms, bathrooms and laundry area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed the required 7-day non-perishable and 2-day perishable foods. Medications and knives locked and inaccessible to residents. Facility has 2 water heaters. Hot water measured at 113.8 in the kitchen. Fire extinguisher was charged with a service date of 6/6/24.

LPA reviewed resident/staff and medication records. Records complete and current.

LPA observed the following posted in the facility: Resident Council Rights, See Something Say Something complaint poster, Reporting Requirements per AB40, Resident Bill of rights, Ombudsman Poster, Resident Personal Rights and facility license posted as required.

The following issues were observed during todays visit: Chemicals/items that could pose a danger to residents observed through out the facility (R1's room, R1's bedroom, backyard, office, laundry room and garage) all unlocked and accessible to resident in care. Water temperature in R1’s bathroom observed at 94.5 degrees F. Back doors observed with auditory alarms not functioning and door locked.

Deficiencies and TV’s provided per Title 22. Exit interview completed with Administrator, Marine. A copy of the report, deficiency, TV’s and appeal rights provided.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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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Document Has Been Signed on 06/11/2024 03:09 PM - It Cannot Be Edited


Created By: Mary Garza On 06/11/2024 at 12:46 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: ASPIRING CARE FACILITY, INC

FACILITY NUMBER: 107209331

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(a)
Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that the facility was observed with chemicals/items that could pose a danger to residents unlocked and accessible to residents in care. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2024
Plan of Correction
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Chemical/items will be collected and locked up as required. Licensee to review regulation for dementia. Pictures to be provided to CCL by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


LIC809 (FAS) - (06/04)
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