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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209501
Report Date: 09/11/2024
Date Signed: 09/12/2024 09:07:52 AM

Document Has Been Signed on 09/12/2024 09:07 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:ZEN HOUSE OF CAREFACILITY NUMBER:
107209501
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, NORA P.FACILITY TYPE:
740
ADDRESS:7251 E. HARVARD AVETELEPHONE:
(559) 577-2632
CITY:FRESNOSTATE: CAZIP CODE:
93737
CAPACITY: 6CENSUS: DATE:
09/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:31 AM
MET WITH:Licensee, Nora SanchezTIME VISIT/
INSPECTION COMPLETED:
02:27 PM
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On 09/11/24 Licensing Program Analysts (LPAs) M. Garza and R. Bruce arrived for an announced pre-licensing inspection visit. LPA was met by Licensees, Nora Sanchez and Administrator, Divina "Grace" Petil. LPAs introduced selves, reason for visit and were permitted entry into the facility.

Facility is in the process of pre-licensing. Currently there are no residents residing at the facility. Fire clearance was approved for 6 non-ambulatory residents.

Tour of facility inside and out was completed. Common areas observed with adequately furnishings and lighting. LPAs observed an extra supply of linens and personal hygiene/grooming products. Kitchen observed with dishes, plates and utensils. Cleaning supplies/chemicals observed in a locked garage cabinet. Medications will be kept in a locked closet in the hallway. Water temperature tested at 108 and 110 degrees F in resident restrooms. Fire extinguisher present and purchased 1/4/24. Smoke and carbon monoxide detectors are present and operational at time of visit. Exits free of obstructions. Facility has a functioning land line phone. Phone number is: (559) 800-8143.

The following issues were observed during todays visit: Stairs in front entry observed without hand railing and lighting. Non-discrimination, Personal Rights of Residents in all Facilities, Additional Personal Rights of Residents in Privately Operated Facilities, visiting policy and complaint postings missing. Grab bar in bathroom #1 missing. No electronic device for resident use observed. First aid kit missing thermometer. Gap around air conditioning unit and right side yard observed with a 2-4 inch drop to level ground. Side gate is not self latching. No covered seating area. Debris observed in back yard in need of removal. Tools observed accessible and unlocked in backyard. Plan of Operation and Disaster Plan incomplete. Patients rights are missing from Admission Agreement.

Due to corrections being needed, the Component III was not conducted during this pre-licensing visit. Pre-Licensing rescheduled for 09/18/24. At this time the facility is not ready to be licensed. Exit interview completed with Licensee, Nora and Administrator, Divina.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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