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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206575
Report Date: 11/08/2025
Date Signed: 11/09/2025 10:10:58 AM

Document Has Been Signed on 11/09/2025 10:10 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:DEAN'S CARE VILLA 110FACILITY NUMBER:
157206575
ADMINISTRATOR/
DIRECTOR:		SANTA MARIA, ELVIRA PFACILITY TYPE:
740
ADDRESS:13110 HINAULT DRIVETELEPHONE:
(661) 218-9151
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 6DATE:
11/08/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:39 AM
MET WITH:Licensee John NoblezaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On 11/8/2025 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct and complete the an annual inspection. LPA was greeted by staff and allowed entrance into the facility. Staff contacted Licensee who arrived shortly after. LPA met with Licensee John Nobleza and conducted tour.

LPA observed the facility to be clean, odor free, and clutter free. The facility is currently licensed for 6 and has a current census of 6. LPA observed all emergency exits to be clear and free from obstruction. LPA observed fire extinguishers to be last serviced 7/19/2025 and with current charge. Facility has 7 bedrooms with 2&1/2 bathrooms. 5 of the 7 bedrooms are for resident and the other 2 rooms are for staff. The master bedroom is a shared room with 2 residents, all other residents have their own room. LPA observed resident bedrooms to be properly furnished with adequate lighting. LPA tested the water temperature in the half bathroom which read at 109 degrees Fahrenheit and in the kitchen which read at 109 degrees Fahrenheit. Smoke & carbon monoxide detectors were tested and are in working condition. LPA observed medications to be locked and inaccessible to residents in care. LPA observed a 7 day supply of non-perishable food items and 2 days worth of perishable food items. LPA reviewed infection control plan which is current and up to date. LPA observed a sample of staff files and resident files which are current and up to date. LPA reviewed medications and did not observe any errors at this time.

LPA observed the following deficiencies which were cited under Title 22: Laundry room door was open with unlocked cabinet which made cleaning supplies and chemicals accessible to residents in care. LPA observed 3 residents with full bed rails, 2 of the 3 residents are on hospice. Licensee was not able to provide doctor's order for full bed rail.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were emailed to Licensee John Nobleza.

NAME OF LICENSING PROGRAM MANAGER: Brenda Chan
NAME OF LICENSING PROGRAM ANALYST: Brianna Miranda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/09/2025 10:10 AM - It Cannot Be Edited


Created By: Brianna Miranda On 11/08/2025 at 01:56 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: DEAN'S CARE VILLA 110
FACILITY NUMBER: 157206575

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/10/2025
Section Cited
CCR
87309(a)

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87309 Storage Space and Access (Unlocked items)
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
This requirement is not met as evidenced by:
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Licensee locked the cabinet and laundry door. Licensee will meet with staff.
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Based on observation & interview, the licensee did not comply with the regulation shown above which poses an immediate Health or Safety and, Personal Rights risk to persons in care. LPA observed the laundry room door to be open with an unlocked cabinet containing cleaning supplies and chemicals.
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Type A
11/10/2025
Section Cited
CCR87608(5)(B)

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87608 Postural Supports (Hospice- Full Bed Rails)
(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
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Licensee will remove bed rails or get doctor's orders for full bedrails.
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Based on observation, interview, and record review, the licensee did not comply with the regulation shown above which poses an immediate Health and Safety or Personal Rights risk to persons in care. LPA observed R1, R2, and R3 to have full bedrails. R1 & R3 are on hospice with no doctor orders for bedrails.
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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.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2025


LIC809 (FAS) - (06/04)
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