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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209425
Report Date: 03/18/2025
Date Signed: 03/18/2025 01:28:46 PM

Document Has Been Signed on 03/18/2025 01:28 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:AMERICAN SENIOR LIVINGFACILITY NUMBER:
157209425
ADMINISTRATOR/
DIRECTOR:
JUAREZ, LINA F DIAZFACILITY TYPE:
740
ADDRESS:9003 DROVERS RUN RDTELEPHONE:
(661) 493-8209
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 4DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH: Licensee/Administrator Lina Juarez and staff Shervin MohammadiTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On 03/18/25, Licensing Program Analysts (LPA) M. Yang arrived unannounced to conduct an annual visit.
LPA introduce self, stated the purpose of the visit and met with Licensee/Administrator Lina Juarez and staff Shervin Mohammadi. All four residents were present during inspection. LPA observed three hospice residents and one non ambulatory resident.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Fire extinguisher was observed with a service date of 02/24/25. Temperature maintained for refrigerator at 37 degrees F and freezer at -4 degrees F. Medications observed locked in kitchen shelf. Medications checked and MAR was reviewed. An adequate supply of perishable and non-perishable food was observed. Cleaning supplies observed stored under kitchen sink, in laundry room cabinet and garage cabinet locked.

All bedrooms were observed to have required furnishings and with adequate lightening. Bathrooms were properly equipped and operational. All bathrooms are observed with securely fastened grab bars and non-skid mat. Extra linens observed in garage cabinets.Outside of facility toured and observed to be free of debris. Adequate outdoor seatings observed for residents. Side gate observed free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational. All residents’ and sample of staff files were reviewed to have all required documents.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 03/24/25.
Forms requested: Lic 308, Lic 500, Lic 610E, and current liability insurance. A copy of this report were provided to the Licensee, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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