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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209397
Report Date: 03/01/2024
Date Signed: 03/28/2024 09:12:32 AM

Document Has Been Signed on 03/28/2024 09:12 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:ALONDRA HOMEFACILITY NUMBER:
157209397
ADMINISTRATOR:LAZAGA, CECILIA& JETHRONELFACILITY TYPE:
740
ADDRESS:9817 ALONDRA DRTELEPHONE:
(661) 563-0683
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 0DATE:
03/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee 1(L1) Ceilia “Cece” Lazaga and Licensee 2 (L2) Jethronel LazagaTIME COMPLETED:
11:30 AM
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On 03/01/24, Licensing Program Analysts (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit and was allowed entry into
the facility. LPA met with Licensee 1(L1) Ceilia “Cece” Lazaga and Licensee 2 (L2) Jethronel Lazaga.

The facility is a 5 bedroom, and 2 bathroom home and fire clearance were granted for 6 non-Ambulatory for a total capacity of 6. LPA toured the facility with L1 and L2. There are no residents present during this inspection. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Medications will be locked in activity room closet. First aid kit was observed and contained all required items.

Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked in kitchen drawer. Refrigerator temperature maintained at 37 degrees F and freezer maintained at 0 degree F. Adequate non-perishable and perishable food supplies observed. LPA observed an extra supply of bed linens, towels, and personal hygiene products. Bedrooms were observed to have the required furnishing and are ready for occupancy. Hot water temperature ranged between 109.9 to 110.8 degrees F in bathroom 1 and between 109 to 109.9 degrees F in master bathroom. Cleaning supplies and chemicals observed to be locked in garage cabinet and under kitchen sink. A fire extinguisher was observed and had a service date of 11/13/23. Smoke detectors and carbon monoxide were observed to be operational during this inspection. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching and free debris.

Component III was conducted during today's pre-licensing visit.

We have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to
CAB in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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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