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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209342
Report Date: 05/17/2023
Date Signed: 05/23/2023 08:29:38 AM

Document Has Been Signed on 05/23/2023 08:29 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:ST. ANTHONY'S SENIOR CARE LLCFACILITY NUMBER:
247209342
ADMINISTRATOR:LOPEZ, MARILYNFACILITY TYPE:
740
ADDRESS:1437 SAN SIMEON COURTTELEPHONE:
(209) 626-5089
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY: 6CENSUS: 3DATE:
05/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Ariel Tolentino - LicenseeTIME COMPLETED:
03:30 PM
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 5/17/2023, Licensing Program Analyst(LPA) D. Ayers arrived at the facility to conduct a Pre-Licensing Inspection. This visit was announced and coordinated with Licensees Ariel Tolentino and Hedy Fernandez. During the inspection, Licensees and LPA spoke with Administrator via telephone.

LPA met with Licensees and toured the facility inside and outside. Pathways and doors were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility fire extinguisher was recently serviced. Facility was clean and odor free. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, had required secure grab bars and non-skid mats, and water temperature was within required temperature range. Sharp items were secured in a locked drawer in the kitchen. A locked cabinet is prepared to store resident medications. The fence had a self-locking latch mechanism and both pool gates were locked. There is adequate outdoor seating for residents. LPA reviewed facility plan of operations and emergency disaster plan.

LPA and Licensee will schedule a follow-up inspection in order to confirm proper resident and staff files, as well as some improvements to the physical plant of the facility. Exit interview was conducted with the Licensees. A copy of the report was provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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 1