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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209341
Report Date: 08/25/2023
Date Signed: 08/25/2023 01:11:24 PM

Document Has Been Signed on 08/25/2023 01:11 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:GOLDRIDGE HOME LLCFACILITY NUMBER:
107209341
ADMINISTRATOR:RIEMER, ROSEMARIE H.FACILITY TYPE:
740
ADDRESS:2145 GOLDRIDGE STTELEPHONE:
(559) 317-7442
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY: 6CENSUS: 0DATE:
08/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, RoseMarie RiemerTIME COMPLETED:
11:41 AM
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On 08/25/2023 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete a pre-licensing visit. LPA met with Administrator, RoseMarie Riemer, explained reason for visit and was permitted entry into the facility. LPA toured facility.

The following issues were observed during last visit and corrected: beds observed with box springs and restrooms observed with grab bar in the shower.

Pre-Licensing has been completed. Component III was completed. No deficiencies cited during todays visit. Facility is ready for License.

Exit interview completed with Administrator, RoseMarie. A copy of this report was given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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