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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209342
Report Date: 06/09/2023
Date Signed: 06/20/2023 08:14:54 AM

Document Has Been Signed on 06/20/2023 08:14 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:
06/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ariel Tolentino - LicenseeTIME COMPLETED:
11:00 AM
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On 6/9/2023, 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.

LPA toured the facility and verified the correction of deficiencies which were previously observed at the facility. Licensees completed Component III presentation. Prelicenisng is complete and this facility has no deficiencies. Exit interview conducted with licensee and a copy of this report was provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2023
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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