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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 355202348
Report Date: 03/01/2023
Date Signed: 03/02/2023 08:42:55 AM

Document Has Been Signed on 03/02/2023 08:42 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:CLEARVIEW CAREHOMES,INC.FACILITY NUMBER:
355202348
ADMINISTRATOR:FELICIDAD RAMOS KANKELBORGFACILITY TYPE:
740
ADDRESS:3370 CIENEGA ROADTELEPHONE:
(831) 637-4463
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 6CENSUS: 6DATE:
03/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Felicidad Ramos Kankelborg-AdministratorTIME COMPLETED:
01:50 PM
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On 3/1/2023, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct a required annual inspection. LPA met with Administrator Felicidad Ramos Kankelborg and announced the purpose of the visit.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Smoke and carbon monoxide detectors were functioning properly. Facility fire extinguishers had current service dates. The last fire drill was conducted on. LPA observed a sufficient supply of perishable and nonperishable foodstuffs which were properly stored. Cleaning supplies and chemicals were inaccessible and secured in locked storage room and below kitchen sink. Sharp items were secured. Medications were secured in a locked cabinet and appeared to be administered properly. LPA toured resident bedrooms and bathrooms. Bedrooms were adequately furnished and lit. Resident bathrooms were clean, odor free, and secure grab bars were located near toilet and in shower. Exterior doors had auditory alert devices installed and working. LPA reviewed resident and staff files. LPA reviewed and discussed the facility Emergency Disaster Plan. LPA and Administrator reviewed fire clearance and requirements for care of bedridden residents.

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: 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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