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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209342
Report Date: 06/11/2024
Date Signed: 06/20/2024 09:06:55 AM

Document Has Been Signed on 06/20/2024 09:06 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/
DIRECTOR:
LOPEZ, MARILYNFACILITY TYPE:
740
ADDRESS:1437 SAN SIMEON COURTTELEPHONE:
(209) 626-5122
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY: 6CENSUS: 3DATE:
06/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Arnel Tolentino - Co-LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 6/11/2023, Licensing Program Analyst (LPA) arrived unannounced to conduct a Required Annual Inspection. LPA met with co-licensee Arnel Tolentino and announced the purpose of the inspection.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Fore extinguisher has a service tag dated 4/5/2024. Smoke and carbon monoxide detectors were present and operational. LPA reviewed facility emergency disaster plan. Facility kitchen and common areas were clean and odor free. LPA observed an adequate supply of perishable and nonperishable foodstuffs which were properly stored. Sharp items and cleaning supplies were secured in locked cabinets. Medications were secured in a locked cabinet, and medications appeared to be properly administered. There was an adequate supply of personal hygiene items and clean linens.

LPA toured resident bedrooms and bathrooms. Bedrooms were clean, odor free, and contained all required minimum furnishings. Bathrooms were clean, odor free, and all fixtures were functioning properly. Hot water was within required temperature range. Showers had required secure garb bars and nonskid mats. LPA reviewed resident and staff records. Records contained required documentation. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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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