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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209477
Report Date: 07/24/2024
Date Signed: 07/24/2024 01:52:32 PM

Document Has Been Signed on 07/24/2024 01:52 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:NOBLE HEARTS ESTATESFACILITY NUMBER:
107209477
ADMINISTRATOR/
DIRECTOR:
SIVILAY,JOHNATHANFACILITY TYPE:
740
ADDRESS:1853 N RYAN AVETELEPHONE:
(559) 351-8836
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY: 6CENSUS: 0DATE:
07/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator Johnathan SivilayTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 07/24/24, Licensing Program Analyst (LPA) V Gorban conducted an announced Pre-licensing visit. LPA met with Administrator Johnathan Sivilay, (certificate number 6056319740 and expiration date 08/16/2025) 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.

The facility was observed at a comfortable temperature of 78 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. At this time, seven day supply of non-perishable food were observed.

Medications and chemicals were kept locked in separate cabinets. Resident’s all six 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.
The bathroom’s water temperature was tested at 115 degrees Fahrenheit. Towels, linens, and personal hygiene supplies were observed in storage.
Outdoor seating area observed and functional for clients to utilize.

Fire extinguisher observed to be current with service date of 03/01/2024. 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 (559-351-8836) present and functional.

Component III was reviewed with Administrator. No deficiencies were observed during 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: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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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