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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209332
Report Date: 06/26/2023
Date Signed: 06/26/2023 11:36:16 AM

Document Has Been Signed on 06/26/2023 11:36 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:LEGACY ADULT CARE LLCFACILITY NUMBER:
107209332
ADMINISTRATOR:MAKARYAN,HRIPSIMEFACILITY TYPE:
740
ADDRESS:2348 E HARVARD AVENUETELEPHONE:
(559) 433-7896
CITY:FRESNOSTATE: CAZIP CODE:
93703
CAPACITY: 6CENSUS: 0DATE:
06/26/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Hripsime "Kristina" Makaryan, LicenseeTIME COMPLETED:
11:50 AM
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On 6/26/23 at 8:24 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a pre-licensing inspection. LPA met with Licensee Hripsime "Kristina" Makaryan.

LPA toured the inside and outside of the facility, and did not observe any obstructions. All bedrooms have sufficient furniture and lighting. One grab bar observed for use of toilet and shower in hallway bathroom. Non-skid mat observed for shower. Linen and toileties observed. Facility set at comfortable temperature. Smoke and carbon monoxide detectors tested and operational. Dishware and utensils observed. Sharps observed inaccessible in kitchen closet. Centrally stored medication observed designated to locked kitchen closet.

The following observed will need to be brought into compliance:
1. Hot water in hallway bathroom measured at 144 degrees F.
2. Fire extinguisher does not have service date or receipt for proof of purchase.
3. First aid kit missing thermometer.
4. Complaint poster (PUB 475), personal rights [87468(c)(1)], and Rights of Resident Councils not posted.
5. Shovel and rake observed in backyard will need to be stored inaccessible.
6. Need updated facility floor plan and yard sketch.

Comp III completed. A follow-up inspection to be scheduled once all above items are in compliance.

Exit interview conducted. A copy of this report was emailed to Licensee with read receipt to confirm receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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