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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209301
Report Date: 07/11/2024
Date Signed: 07/11/2024 12:06:29 PM

Document Has Been Signed on 07/11/2024 12:06 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:SENIOR CARE COMFORT LIVINGFACILITY NUMBER:
547209301
ADMINISTRATOR/
DIRECTOR:		MELANIE RAFANANFACILITY TYPE:
740
ADDRESS:720 SOUTH CHINOWTH ROADTELEPHONE:
(559) 303-8043
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: 0DATE:
07/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator:Melanie Rafanan and Licensee Jose PiraTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA's) K.Kaur and J. Leffall conducted a Pre-licensing Inspection on this date. LPA's met with Licensee/Administrator Melanie Rafanan and Jose Pira. A tour of the facility was conducted together. This is a new facility with no residents in care. The facility was observed to be at a comfortable temperature, and in good repair. LPA’s did not observe operational telephone service. No passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. LPA’s observed Dining table located in kitchen. Table is not sufficient for 6 residents. Knives and sharps are locked in cabinet in kitchen. Fire extinguisher observed in the kitchen with a service date of 3/26/2024. Medications will be locked in cabinet located in kitchen area. Scissors not observed in First Aid Kit. Living room is equipped with adequate futon and chairs for residents. Cleaning and Chemical supplies observed locked in laundry room next to the washing machine. Resident’s bedrooms were observed to be adequately furnished with bed, dresser, chair and adequate lighting. LPAs did not observe nightstands in resident rooms. Mattresses and linen were in good condition. Extra linen and towels are available in the hallway cabinets. Carbon monoxide and smoke alarm detectors installed and operational. Grab bars installed in shower and by toilet, non-skid mats in place, hand soap and paper towels available for use. Trash cans with tight fitting lids are in place. Complaint poster posted, resident council info posted, residents' rights posted, emergency disaster plan posted. LPA’s did not observe nondiscrimination and theft policy. Adequate outside space for rest and recreational under a patio with sufficient seating. LPA’s observed excess broken items. LPA’s observed unlocked garden tools and ax in backyard. Gate is self-closing and self-latching.

The following issues will need to be corrected prior to pre-licensing visit and Licensure of facility:

1. Liability Insurance

2. Facility Telephone Service

Continued to LIC 809C

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SENIOR CARE COMFORT LIVING
FACILITY NUMBER: 547209301
VISIT DATE: 07/11/2024
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3. Post nondiscrimination and theft policy

4. Licensee to lock garden tools, ax, sharps.

5. Remove broken items in backyard not in use.

6. Missing scissors from First Aid Kit

7. Night-stand in each resident room

Pre-licensing requirements were not met. An exit interview was conducted with Licensee/Administrator. Report signed on-site by Licensee and printed copy provided

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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