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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209386
Report Date: 11/08/2023
Date Signed: 11/08/2023 10:07:43 AM

Document Has Been Signed on 11/08/2023 10:07 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:RADIANCE SENIOR CAREHOMEFACILITY NUMBER:
107209386
ADMINISTRATOR:BAUTISTA, ARLENEFACILITY TYPE:
740
ADDRESS:707 W CHENNAULT AETELEPHONE:
(559) 704-6796
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 0DATE:
11/08/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator 1 (A1) Arlene Bautista and Administrator 2 (A2) Elisa PuaTIME COMPLETED:
10:20 AM
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On 11/08/23, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection for Change of Location. LPA introduced self, stated the purpose of the visit, and was allowed entry into the facility. LPA met with Administrator 1(A1) Arlene Bautista and Administrator 2(A2) ELisa “Lisa” Pua. LPA tour facility with A1 and A2.

The facility is a 5 bedroom and 2 bathroom home and fire clearance were granted for 6 Non-Ambulatory for a
total capacity of 6. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available.

Kitchen observed to have dishes, plates, utensils. Knives was kept locked and secure under kitchen sink. LPA observed a 2 day supply of perishable foods and a 7 day supply of non-perishable foods. Refrigerator temperature observed maintained at 34 degree F and freezer temperature maintained at -7 degree F. Medications will be locked in kitchen shelve and in hall closet. Cleaning supplies and chemicals observed to be locked under kitchen sink and in laundry room. A fire extinguisher was observed and had a service date of 05/12/23. First aid kit was observed and contained all required items. Bedrooms were observed to have the required furnishing and are ready for occupancy. Bathrooms were observed functional and operational during inspection. Hot water temperature 120 degree F in bathroom 1 and range between 118.9 to 118.8 degree F in master bathroom. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Outside of facility toured. Exits were open and free of obstructions. Side gate observed self-closing and self-latching. LPA observed adequate outdoor seatings available for residents. Smoke detectors and carbon monoxide were observed to be operational during this inspection.

Component III was conducted during today's pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB
in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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