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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208847
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:05:09 PM

Document Has Been Signed on 10/11/2023 03:05 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:JAMES LINWOOD RCHFACILITY NUMBER:
547208847
ADMINISTRATOR:VILLELA, LETICIAFACILITY TYPE:
740
ADDRESS:111 1/2 S LINWOOD STTELEPHONE:
(559) 732-8992
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 6CENSUS: 4DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Leticia Villela, Licensee/AdministratorTIME COMPLETED:
03:20 PM
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On 10/22/23 at 12:26 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry by Licensee/Administrator (LIC) Leticia Villela.

LPA toured inside and outside the facility. Facility set at comfortable temperature. Smoke and carbon monoxide detectors tested and operational. All bedrooms observed with sufficient furnishings and lighting. Non-skid mats observed in showers. Grab bars observed for each toilet and shower. Sharps observed locked. Food supply observed sufficient. Centrally stored medication observed locked. Staff and resident records reviewed. Administrator certificate valid.

No deficiencies cited during this inspection.

An exit interview was conducted. A copy of this report was left with Licensee, whose signature on this form confirms receipt of these documents.

The following updated forms are to be submitted to CCL within two weeks:

LIC308, LIC500, LIC9020, LIC610E, Proof of liability insurance

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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