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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203951
Report Date: 06/01/2023
Date Signed: 06/01/2023 10:42:37 AM

Document Has Been Signed on 06/01/2023 10:42 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:ST. CATHERINE'S HOME CARE, INC.FACILITY NUMBER:
157203951
ADMINISTRATOR:NECER, AMALIAFACILITY TYPE:
740
ADDRESS:10214 PINNACLE RIDGE AVE.TELEPHONE:
(661) 665-9405
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 5DATE:
06/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Amalia NecerTIME COMPLETED:
10:30 AM
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Amend report

On 06/01/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA arrived and was greeted by caregiver Alwyn Navor. LPA introduced self, stated the purpose of the visit, and was granted entry. The purpose of this visit is to conduct a Plan of Correction (POC) visit to verify that all staff files have the required documents for the deficiency cited on 05/26/23 visit. Administrator Amalia Necer was contacted and arrived shortly.

LPA reviewed staff files and observed to have the required documents.

Deficiency cited on 05/26/23 cleared. POC letter provided to Administrator during visit.

No deficiencies cited during this visit. An exit interview conducted. A copy of this report was provided to Administrator.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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