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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209523
Report Date: 01/07/2026
Date Signed: 01/08/2026 04:04:44 PM

Document Has Been Signed on 01/08/2026 04:04 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:DIVINE MERCY CARE HOMES IIFACILITY NUMBER:
157209523
ADMINISTRATOR/
DIRECTOR:		ORILLOSA, NEILFACILITY TYPE:
740
ADDRESS:10200 LERWICK AVETELEPHONE:
(661) 412-4845
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 5DATE:
01/07/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Licensee/ Administrator (L1) Neil Orillosa via telephone and Manager Jade Gomez TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 01/07/26, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with caregiver John Baniage. Licensee/ Administrator (L1) Neil Orillosa was called and stated unable to attend meeting. L1 informed LPA manager (S1) Jade Gomez will arrive shortly and L1 authorized S1 to sign and receive report.

LPA toured facility with S1. All residents were present during inspection of which 3 residents are receiving hospice care. Residents were observed sitting in the common areas and in the bedroom during tour. 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. Washer and dryer was operational during visit.

All residents’ and a sample of staff files were reviewed. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature is maintained at 35 degrees F and freezer at -1 degrees F. Cleaning solutions were observed locked under kitchen sink with a broken lock. A small knife was observed locked in the kitchen drawer.

Medications were observed locked in kitchen shelves. MARs were reviewed and medications were checked. First aid kit was checked. Fire extinguisher was observed with a service date of: 03/31/25. All bedrooms were observed to have the required furnishings and with adequate lightning. R1 was observed laying in bedroom using full rails and R3 bed was observed with half rails up.

Extra linens and towels were observed. The bathrooms were toured and observed with non-skid mats and grabbed bars. Hot water tested at 105.2 and 105.5 degrees F in the bathroom in master bedroom, and 105.2 degrees F in hall bathroom.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2026
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: DIVINE MERCY CARE HOMES II
FACILITY NUMBER: 157209523
VISIT DATE: 01/07/2026
NARRATIVE
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Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching. Adequate outdoor seating was available for residents. Carbon monoxide and smoke detector operational during visit.

Technical Support Program (TSP) assistance was offered. Licensee will make a decision and reach out the department regarding acceptance.



A deficiency and an immediate Civil Penalty was assessed. See Lic 421BG is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6 see attached Lic 809D.

Exit interview was conducted. The following documents are requested and submitted to Fresno CCL by: 01/13/26. Forms requested: Lic 308, Lic 500, Lic 610E, and current liability insurance. Plan of correction was discussed with Licensee/ Administrator via telephone. Manager, whose signature on this form. A copy of reports and appeal rights was emailed to Licensee per request.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 01/08/2026 04:04 PM - It Cannot Be Edited


Created By: Mai Yang On 01/07/2026 at 02:28 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: DIVINE MERCY CARE HOMES II
FACILITY NUMBER: 157209523

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(2)
87355(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)…

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, interview conducted and observation, S2 is working providing care and supervision for residents. S2 is fingerprinted cleared who is not associated to the facility, which poses an immediate risk to the health and safety of the residents.
POC Due Date: 01/08/2026
Plan of Correction
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S2 is to be removed from the facility immediately. S2 is not permitted back until associated. Licensee is to submit LIC 9182 or associate S2 on Guardian. Proof of S2 associated to the facility will be submitted to Fresno CCL by POC due date 01/08/26.
Type A
Section Cited
CCR
87309(a)
87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA and S2 observed cleaning solutions unlock under kitchen sink and bathroom sinks, a knife unlocked in the kitchen drawer, and chemicals unlock in the laundry room accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/08/2026
Plan of Correction
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Staff immediately removed and locked the chemicals and the knife. POC cleared during visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/08/2026 04:04 PM - It Cannot Be Edited


Created By: Mai Yang On 01/07/2026 at 02:31 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: DIVINE MERCY CARE HOMES II
FACILITY NUMBER: 157209523

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(5)(B)
87608(a)(5)(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:
Deficient Practice Statement
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Based on observation and records reviewed, R1 is on hospice care and was observed lying bed using a hospital bed with full rail with no doctor’s order, which poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 01/16/2026
Plan of Correction
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Licensee shall obtain doctor orders for R1 who’s currently receiving hospice care that specific the need for full bed rails. If R1 is not eligible for hospice evaluation to retain a full bed rail, seek physician order for half bed rails and remove full bed rails. Order shall be obtained and submitted to Fresno CCL by POC due date 01/16/26.
Type B
Section Cited
CCR
87608(a)(3)
87608 (a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and records reviewed, R3 uses a ½ rail bed. There is no doctor’s order for ½ rail bed for R3, which poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 01/16/2026
Plan of Correction
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Licensee will obtain doctor orders for R3 indicating the need for half bed rail if physician indicates the need for half bed rail. If physician do not indicate the need for the half rails, the half rails will be removed by POC due date 01/16/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/08/2026 04:04 PM - It Cannot Be Edited


Created By: Mai Yang On 01/07/2026 at 02:32 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: DIVINE MERCY CARE HOMES II
FACILITY NUMBER: 157209523

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(d)(3)
87465 (d)(3) The date and time the PRN medication was taken, the dosage taken, and the resident’s response shall be documented and maintained in the resident’s facility record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews and records reviewed, R4’s PRN medication Aspirin 81mg, PRN medication Lorazepam 0.5 mg and PRN medication Ondansetron 4mg were not record in the resident’s MAR, which poses a potential health and safety risk for the person in care.
POC Due Date: 01/09/2026
Plan of Correction
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Licensee shall ensure that all R3’s medications are record into the resident’s MARs and will submit to Fresno CCL by the POC due date 01/09/26.
Type B
Section Cited
CCR
87465(h)(6)
87465 (h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview conducted, observation, and records reviewed, all 3 residents taking medications, the residents’ current medications were received and was not record in Centrally Stored Medication Record (Lic 622), poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 01/13/2026
Plan of Correction
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Licensee shall ensure that all the residents’ medications are recorded in the Lic 622 and submitted to Fresno CCL by POC due date 01/13/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2026


LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 01/08/2026 04:04 PM - It Cannot Be Edited


Created By: Mai Yang On 01/07/2026 at 02:33 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: DIVINE MERCY CARE HOMES II
FACILITY NUMBER: 157209523

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)
87412(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview conducted, observation, and records reviewed, S2 was hired on 12/21/25 with no staff records on file, poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 01/23/2026
Plan of Correction
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Licensee shall ensure that facility has S2 completed file on file by POC due date. S2’s Lic 501, Lic 503 with TB results, current first aid certification, and 40 hours orientation training will submit to Fresno CCL by POC due date 01/23/26.
Type B
Section Cited
CCR
87633(b)
87633(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident…

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review and interview conducted with Licensee, R1 and R4 are currently receiving hospice care with no hospice care plan on file, which poses a potential health or personal rights risk to persons in care.
POC Due Date: 01/16/2026
Plan of Correction
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Licensee shall obtain hospice care plan for R1 and R4 and submit it to Fresno CCL by POC due date 01/16/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2026


LIC809 (FAS) - (06/04)
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