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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209377
Report Date: 09/24/2024
Date Signed: 09/24/2024 12:54:48 PM

Document Has Been Signed on 09/24/2024 12:54 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:BURLINGTON, THEFACILITY NUMBER:
157209377
ADMINISTRATOR/
DIRECTOR:		GIBSON, KALAFACILITY TYPE:
740
ADDRESS:13 SYCAMORE DRTELEPHONE:
(415) 810-0145
CITY:WOFFORD HEIGHTSSTATE: CAZIP CODE:
93285
CAPACITY: 21CENSUS: 13DATE:
09/24/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Licensee Anthony BarbatoTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On 09/24/24, Licensing Program Analyst (LPA) M. Yang arrived announced to conduct a pre-licensing inspection for the change of status/increase in capacity inspection. LPA was greeted by Licensee Anthony Barbato. LPA introduced self and stated the purpose of the visit. LPA toured the facility inside and outside with Licensee.

LPA received the fire clearance which was granted by Kern County Fire Department. Fire clearance was granted for an additional 1 non-ambulatory resident to occupy the dwelling for a total of 22 capacity.

Adequate nonperishable and perishable food were observed. Adequately outdoor seatings observed for the residents. The department has found room 8 which is 12 feet by 10.6 feet is ready for increase for 1 resident to be occupant at the facility for a total of 22 capacity.

An exit interview was conducted. The department will send Licensee new license via mail. A copy of this report was provided to Licensee, whose signature confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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