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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209284
Report Date: 03/01/2023
Date Signed: 03/01/2023 02:59:44 PM

Document Has Been Signed on 03/01/2023 02:59 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:ONE ACCORD RCFEFACILITY NUMBER:
247209284
ADMINISTRATOR:WANJAU, JOHNSON KAMUNYAFACILITY TYPE:
740
ADDRESS:1079 OHKI STTELEPHONE:
(951) 941-5192
CITY:LIVINGSTONSTATE: CAZIP CODE:
95334
CAPACITY: 6CENSUS: 0DATE:
03/01/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Admininstrator, Kamunya, Johnson WanjauTIME COMPLETED:
01:00 PM
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On 3/1/2023 Licensing Program Analysts (LPAs) V Gorban and B Miranda arrived at facility to complete an announced Pre-Licensing visit. LPA met with Administrator (AD) Kamunya, Johnson Wanjau.
LPAs toured the facility inside and out. During the tour AD stated all four bedrooms will be occupied by residents.

LPAs observed the following deficiencies:
1. Application for capacity of six as stated per CAB, only three (3) rooms are available to be unutilized by residents.
2. Only one room available to accommodate two residents, other rooms will need to be furnished and ready for residents to move in.
3. Residents rooms are not adequately furnished.
4. Chemicals in the facility are not locked and exposed to potential danger to residents in care.
5. Non-slip mats are missing in showers.
6. Medication box needs to be locked
7. Fire extinguisher needs be updated
8. Trash can lids are missing in the bathrooms.


Pre-licensing is incomplete with deficiencies to be resolved by 3/15/23. A follow up pre licensing LIC 809 will be generated upon resolution of the deficiencies. Another facility visit will be conducted on 3/15/23, 10am.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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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