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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208987
Report Date: 09/04/2026
Date Signed: 09/04/2026 02:03:05 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/04/2026 02:03 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:CHERRY AND MICHAEL'S HOMEFACILITY NUMBER:
107208987
ADMINISTRATOR/
DIRECTOR:		ALACAR. CAROLINEFACILITY TYPE:
740
ADDRESS:4640 E KAVILANDTELEPHONE:
(559) 515-6120
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY: 4CENSUS: 4DATE:
09/04/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Jason Gavilan, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 09/4/26, Licensing Program Analysts (LPA) M. Yang arrived unannounced to conduct an annual visit.
LPA introduce self, stated the purpose of the visit and requested to meet with Administrator. LPA was greeted by Program Manager (S1) Jason Gavilan. Administrator (A1) Caroline Alacar was called, stated unavailable to attend meeting, and authorized Program Manager to sign and receive report. LPA toured facility with S1. One resident was present during inspection. R1 was observed in the common area with wheelchair seatbelt on.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. First aid kit observed with required items.
Fire extinguisher was observed with a service date of 08/19/25. Temperature maintained for refrigerator at 30 degrees F and freezer at 0 degrees F. 2 days perishable food and 7 days non-perishable food were observed.

Expired nonperishable and perishable food observed in the kitchen. Cleaning supplies observed locked under kitchen sink and laundry room shelves. All bedrooms were observed to have required furnishings and with adequate lighting. Bathrooms toured and observed with securely fastened grab bars and non-skid mats. Hot temperature tested to be maintained at 105.4 degree F in both bathrooms. Extra linens and towels observed in hall closet.

(CONTINUED TO LIC 809C)
See Moua
Mai Yang
DATE: 09/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: CHERRY AND MICHAEL'S HOME
FACILITY NUMBER: 107208987
VISIT DATE: 09/04/2026
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(CONTINUED FROM LIC 809)

Outside of facility toured and observed to be free of debris. Adequate outdoor seating is available for residents. Side gate observed self-closing. Carbon monoxide and smoke detectors were tested and observed to be operational. Medications observed locked in cabinets. MARs were reviewed and medications were checked. All residents and a sample of staff files were reviewed to have all required documents.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6 see attached 809D.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 09/10/26. Forms requested: Lic 308, Lic 500, Lic 610E, current liability insurance, and current Administrator certificate. A copy of this report and appeal rights were provided to the S1, whose signature on this form confirms receipt of this report.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/04/2026 02:03 PM - It Cannot Be Edited


Created By: Mai Yang On 09/04/2026 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CHERRY AND MICHAEL'S HOME
FACILITY NUMBER: 107208987

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2026
Section Cited
CCR
87465(d)(3)

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87465(d)(3) The date and time …medication was taken, the dosage taken, and the resident’s response shall be documented and maintained in the resident’s facility record.

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Program Manager record in R1’s MARs. Licensee will submit a written statement of steps the facility will take to ensure when medications are being administered it’s recorded in the residents’ MAR to the Fresno CCL by POC due date 09/05/26.
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Based on interview conducted, observations, and records reviewed, R1’s medication Aspirin EC 81 mg and Calcium Citrate 200mg were administered on 09/04/26 at 8AM and not record in the resident’s MAR, which poses/posed an immediate health and safety risk for the person in care.
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Type A
09/05/2026
Section Cited
CCR87555(b)(8)

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87555(b)(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state, and local authorities. Good in damaged containers shall not be accepted, used, or retained.

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Staff disregarded expired food. POC cleared during visit.
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Based on observation, expired fruits, perishable food, and nonperishable food were observed, poses/posed an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/04/2026 02:03 PM - It Cannot Be Edited


Created By: Mai Yang On 09/04/2026 at 12:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CHERRY AND MICHAEL'S HOME
FACILITY NUMBER: 107208987

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2026
Section Cited
CCR
87405(d)(2)

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87405(d)(2) Administrator-Qualifications and Duties. The administrator shall have the knowledge of and ability to conform to applicable laws, rules and regulations.

This requirement is not met as evidenced by:
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Fire extinguisher shall be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by POC due date 09/05/26.
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Based on observation, Fire Extinguisher has a service date of 08/19/25, which poses an immediate health and safety risk to the residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/04/2026 02:03 PM - It Cannot Be Edited


Created By: Mai Yang On 09/04/2026 at 12:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CHERRY AND MICHAEL'S HOME
FACILITY NUMBER: 107208987

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2026
Section Cited
CCR
87608(a)(3)

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87608 (a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

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The facility shall obtain physician order for wheelchair seat belt and submitted by POC due date. An exception for wheelchair seatbelts is to be requested and submitted to Fresno CCL office by POC due date 09/14/26.
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Based on observation, interview conducted, and records reviewed, R2 was observed sitting in wheelchair with a seatbelt latched on with no doctor’s order, which poses/posed a potential health and safety risk to the residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2026


LIC809 (FAS) - (06/04)
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