<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167209143
Report Date: 08/15/2023
Date Signed: 08/15/2023 12:31:19 PM

Document Has Been Signed on 08/15/2023 12:31 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:SPARKS' RESIDENTIAL MEADOWBROOKFACILITY NUMBER:
167209143
ADMINISTRATOR:SPARKS, CEIARAFACILITY TYPE:
740
ADDRESS:983 S GREEN STREETTELEPHONE:
(559) 772-8385
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 6CENSUS: 5DATE:
08/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee/Administrator Ceiara Sparks and Lead Dana CurryTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/15/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA was greeted by Laura Hudson. LPA introduced self, stated the purpose of the visit and request to meet with Administrator. LPA was granted entry. Licensee/Administrator Ceiara Sparks was called and arrived shortly. LPA conduct tour with Licensee and Lead Dana Curry. One resident was present upon arrival and depart during inspection for appointment. Licensee depart later during inspection and authorized Lead to receive and sign report.

The tour started in the kitchen into the common areas, to the resident's bedrooms, and bathrooms. The facility was observed to be at a comfortable temperature of 75 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Temperature maintained for refrigerator at 36 degrees F and freezer at 0 degrees F. Cleaning supplies and chemicals stored and locked under in laundry cabinet. Fire extinguisher was observed with a service date of: 03/20/23. Fire drill last completed: 07/24/23. Medications observed kept locked in medication drawer. MARs were reviewed. All bedrooms were observed to have required furnishings and with adequate lightening. Bathrooms were properly equipped, and the hot water temperature was tested at 105.4 in bathroom. Outside of facility toured and observed to be free of debris. Adequate outdoor seatings available for residents. All residents’ file reviewed to have update emergency contacts, Admission agreement, and Pre-Appraisal. Staff files reviewed to have current First Aid/CPR certification. Carbon monoxide and smoke detectors were tested and observed to be operational. First Aid kit observed with all required items.



No deficiencies issued during this inspection.

Exit Interview conducted. LPA received a copy of Lic 9282. The following documents are requested and submitted to Fresno CCL by: 08/22/23. Forms requested: Lic 308, Lic 500, Lic 610E, updated facility sketch, current liability insurance, current Administrator Certificate. A copy of this report was provided to Lead, whose signature on this form confirms receipt of this report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3