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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209142
Report Date: 01/05/2024
Date Signed: 01/27/2024 08:46:41 PM

Document Has Been Signed on 01/27/2024 08:46 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:OAKHURST BOARD AND CAREFACILITY NUMBER:
207209142
ADMINISTRATOR:LEANG, LUCYFACILITY TYPE:
740
ADDRESS:41456 PAMELA PLACETELEPHONE:
(559) 293-3174
CITY:OAKHURSTSTATE: CAZIP CODE:
93644
CAPACITY: 11CENSUS: 6DATE:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Caregiver K. McKinnyTIME COMPLETED:
12:15 PM
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On 1/5/23 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct a case management visit. LPA met with the two staff members at the facility. LPA spoke with Ester from Admin over the phone, staff member K. McKinny assisted LPA at the facility during the visit.

LPA spoke with Ester regarding an incident report that was submitted 12/14/23 to LPA's email account regarding R1's incident that occurred 11/12/23. Ester stated it was a typo and the incident occurred 12/12/23, LPA informed Ester to submit a revised incident report for R1. Facility provided a revised incident report with the correct date and activity log for the date the incident occurred by 1/9/24.

An incident report was submitted for R2 which resulted in a change of condition. Ester stated the incident report was originally sent to LPA on 12/21/23, and the follow-up incident report was sent 1/3/24. LPA was able to confirm. LPA was not able to locate S2's current LIC602A, reappraisal, health care plan and verification of staff training for R2. The facility will provide the information to LPA by 1/9/24. The resident actively log indicates R2 was discharged and back at the facility as of 1/2/24.

At this time no deficiencies were cited

Exit interview was conducted with Ester over the phone and a copy of this report LIC809 was provided to Caregiver K. McKinny who will be signing the report.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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