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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209043
Report Date: 03/13/2025
Date Signed: 03/13/2025 02:57:20 PM

Document Has Been Signed on 03/13/2025 02:57 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CEDAR CREEK SENIOR LIVINGFACILITY NUMBER:
207209043
ADMINISTRATOR/
DIRECTOR:		ELDRIDGE, KIMBERLYFACILITY TYPE:
740
ADDRESS:500 N. WESTBERRY BLVD.TELEPHONE:
(559) 673-2345
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 162CENSUS: 79DATE:
03/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Kelly Reynolds, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 3/13/2025, Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct a case management visit. LPA met with Administrator (AD) Kelly Reynolds and explained the reason for the visit.

CCL received an incident report in January, 2025 regarding Resident (R1) whose family called 911 to have him go to the hospital for a foot ulcer. LPA inquired if R1 had entered the facility with the issue or if had developed the ulcer while under their care. LPA was provided with a copy of R1's pre assessment which reflected that there was an existing foot wound at the time he came under their care. R1's family called 911 to get his foot addressed as they felt that they wanted him to have the doctor look at it. R1 had alot of medical issues at the time and the foot ulcer was just one of R1's medical concerns. R1 entered the facility on January 10 and went to the hospital on January 19, 2025 for his foot. R1 never did return to the facility and ultimately passed away on February 9, 2025 due to medical conditions not necessarily related to the foot ulcer.
LPA and AD discussed pre-assessments and incident reporting and the need to include as much information as possible.

No citations issues at today's visit.

See LIC811 for confidential names list.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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