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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209357
Report Date: 11/28/2023
Date Signed: 11/28/2023 01:09:00 PM

Document Has Been Signed on 11/28/2023 01:09 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:LOTUS SENIOR LIVING CENTERFACILITY NUMBER:
107209357
ADMINISTRATOR:SHARMA, PAWANAFACILITY TYPE:
740
ADDRESS:4081 SCOTT AVE.TELEPHONE:
(559) 500-8706
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY: 6CENSUS: 0DATE:
11/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator, Pawana SharmaTIME COMPLETED:
10:57 AM
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On 11/28/23, Licensing Program Analyst (LPA) V Gorban conducted announced Pre-licensing visit. LPA met with Licensee, Pawana Sharma, certification number 6067993740, expiration date 08/22/2025 and discussed the purpose of the visit.

LPA began the tour at the entrance of the facility that has one entrance point. LPA toured the inside and outside of the facility. LPA observed no obstruction to emergency exit from back yard of the facility on west sides.

The facility was observed at a comfortable temperature of 75 degrees Fahrenheit, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas furnished and well-lit throughout. LPA observed the kitchen to be absent of any trash or debris, sharp objects are secured and inaccessible to residents. A two day supply of perishable and seven day supple of non-perishable food observed.

Medications and chemicals were kept locked in cabinets. Resident’s all five bedrooms were observed to be furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains.

Bathrooms and showers were equipped with non-skid mats and securely fastened grab bars. Bathroom water temperature was tested at 105 degrees Fahrenheit. Towels, linens, and personal hygiene supplies were observed in storage. There are no bodies of water outside.

Report continues on LIC809-C

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: LOTUS SENIOR LIVING CENTER
FACILITY NUMBER: 107209357
VISIT DATE: 11/28/2023
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All Fire extinguishers are current. Carbon monoxide and smoke detectors were observed to be operational. First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, required phone numbers, and required postings were observed. A working facility telephone number (559-767-6033) was present and functional.

Component III was reviewed with Administrator.

No deficiencies were observed on this visit. Report will be submitted Centralize Application Bureau for record and further processing of application.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
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