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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203358
Report Date: 12/16/2024
Date Signed: 12/16/2024 04:31:03 PM

Document Has Been Signed on 12/16/2024 04:31 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:POSITIVE DIRECTIONS #9FACILITY NUMBER:
157203358
ADMINISTRATOR/
DIRECTOR:		MARIA ORTIZFACILITY TYPE:
740
ADDRESS:329 EL CAMINO DRIVETELEPHONE:
(661) 721-3525
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 4CENSUS: 4DATE:
12/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:16 PM
MET WITH:Administrator Alicia Maria OrtizTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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LPAs K.Kaur and L. Salazar questioned Administrator regarding incident report dated 11/1/2024 regarding Resident 1 (R1). Cross Report received from Day Program indicated change in condition for resident was reported to "House Manager" (Patricia) S1. Review of Facility Personnel Report Summary did not have House Manager S1 listed. Administrator provided LPAs proof of finger print clearance for S1, however, review of Guardian and Licensing Information System shows S1 is not associated to the facility.

Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22,


Division 6 and an immediate civil penalty is being assessed in the amount of $500.

An exit interview was conducted with Administrator Alicia Maria Ortiz. Report signed on-site by Administrator, whose signature on the form confirms receipt of this document.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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Document Has Been Signed on 12/16/2024 04:31 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 12/16/2024 at 03:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: POSITIVE DIRECTIONS #9
FACILITY NUMBER: 157203358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/17/2024
Section Cited
CCR
87355(c)

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87355 Criminal Record Clearance (c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department:

This requirement is not met as evidenced by:
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Licensee to associate staff immediately or submit documents to CCLD office by due date.
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Based on file review; House Manager S1 is not associated with the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2024


LIC809 (FAS) - (06/04)
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