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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209526
Report Date: 07/16/2025
Date Signed: 07/16/2025 11:45:13 AM

Document Has Been Signed on 07/16/2025 11:45 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:ROSAMOND GARDENSFACILITY NUMBER:
157209526
ADMINISTRATOR/
DIRECTOR:		PEREZ, VIVIANA A.FACILITY TYPE:
740
ADDRESS:2324 HAY MARKET STTELEPHONE:
(951) 999-7944
CITY:ROSAMONDSTATE: CAZIP CODE:
93560
CAPACITY: 6CENSUS: 0DATE:
07/16/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Leslie Green Licensee and Licensee/Administrator Viviana Perez TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On 07/16/25, 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/Administrator (L1) Viviana Perez. Licensee 2 (L2) Leslie Green arrived shortly during inspection. LPA toured the facility with L1 and L2.

The facility is a 3 bedroom, and 2 bathroom home and fire clearance were granted for 4 Ambulatory and 2 non-Ambulatory for a total capacity of 6. 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 under the hallway counter and in mini refrigerator. First aid kit was observed and contained all required items. A fire extinguisher was observed throughout the facility with service date of 11/21/24. Chemicals observed locked in garage cabinet.

Kitchen was toured and observed to have dishes, plates, and utensils. Knives were locked in box. Refrigerator temperature was maintained at 34 degrees F and freezer maintained at 0 degree F. Adequate non-perishable food supplies observed. Perishable food will be purchased prior to first resident residing at the facility. 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.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2025
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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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: ROSAMOND GARDENS
FACILITY NUMBER: 157209526
VISIT DATE: 07/16/2025
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Smoke detectors and carbon monoxide were observed to be operational during this inspection. Outside of facility toured. Exits were open and free of obstruction. LPA observed the side gate to be self-latching and free debris. Adequate outdoor seating observed available for residents.

Facility phone number 661-386-9973.

Hot water was not tested during inspection. Water heater in disrepair.

The following items will need to be corrected prior to licensure:
1. Hot water maintained at temperature 105 to 120 degree F.

Licensee will contact LPA to conduct a follow-up inspection.An exit interview was conducted, and list of correction was discussed.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC809 (FAS) - (06/04)
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