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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204131
Report Date: 06/23/2026
Date Signed: 06/24/2026 04:36:46 PM

Document Has Been Signed on 06/24/2026 04:36 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:RIVERSTONE TERRACE SENIOR LIVING MEMORY CAREFACILITY NUMBER:
157204131
ADMINISTRATOR/
DIRECTOR:		RICE, DOUGLAS G.FACILITY TYPE:
740
ADDRESS:3115 BROOKSIDE DRTELEPHONE:
(661) 663-9671
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 40CENSUS: 30DATE:
06/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Administrator Douglas Rice and Licensed Vocational Nurse Casey Gonzales TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On 06/23/26, Licensing Program Analyst (LPA) M. Yang arrived at the facility unannounced to conduct the Annual Inspection. LPA met and toured facility with Administrator Douglas Rice.

Facility has sufficient furnishings inside and outside for resident use. LPA observed exits to have a 15-second delay egress. The facility was observed to be at a comfortable temperature, clean, and no passageway obstructions or fire hazards. Residents were observed seating in common areas. Facility is equipped with pull stations and fire sprinklers throughout the facility. Fire extinguisher was observed throughout the facility with a service date of: 09/09/2025. LPA toured kitchen. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Food are prepared at Riverstone Terrance Senior Living and kept warm during transport to the resident during each meals in a cart. Chemicals stored and locked in house keeping’s room. A sample of resident bedrooms was toured. Hot water temperature was tested and measured to be maintained at 96.2 degrees F in room D7, 91.9 degrees F in room D7, 91.9 degrees F in room A6, 93.7 degrees F in room B8, and 99.5 degrees F in room C6. LPA observed securely fastened grab bars in bathrooms. Nonskid strips in residents’ showers. Flooring in the laundry room was observed in disrepair near the washer and dryer. Medications are kept lock in medication cart. A sample of residents’ files was reviewed. Courtyard was toured and observed with available seating for residents with shade. Carbon monoxide was observed operational during visit.

Technical Support Program (TSP) assistance was offered. Administrator will make a decision and reach out the department regarding acceptance.



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 was conducted. The requested documents are to be submitted to the department by 06/26/6: Lic 308, Lic 500, Lic 610E and current liability insurance. A copy of this report and appeal rights were provided to the Administrator.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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)
Page: 2 of 4
Document Has Been Signed on 06/24/2026 04:36 PM - It Cannot Be Edited


Created By: Mai Yang On 06/23/2026 at 02:52 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: RIVERSTONE TERRACE SENIOR LIVING MEMORY CARE
FACILITY NUMBER: 157204131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
87303 (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, flooring in the laundry room was observed in disrepair, poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 06/29/2026
Plan of Correction
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Laundry room flooring will be in good repair by POC due date. Proof of repair will be submitted to the Fresno CCL by POC due date 06/29/26.
Type B
Section Cited
CCR
87303(e)(2)
87303 (e)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).

This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on observation, hot water temperature was tested and measured to be maintained at 96.2 degrees F in room D7, 91.9 degrees F in room D7, 91.9 degrees F in room A6, 93.7 degrees F in room B8, and 99.5 degrees F in room C6, which poses/ posed a potential health and safety risk for the person in care.
POC Due Date: 06/29/2026
Plan of Correction
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The facility shall maintain hot water temperatures between 105 degree F and 120 degree F. The facility will have a daily temperature log to ensure water temperature meets the regulation requirements. Daily temperature log with proof of hot water temperature is tested and maintained between 105 degree and 120 degree F shall be submitted to the Fresno CCL office by 06/29/26.
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: 06/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2026


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/24/2026 04:36 PM - It Cannot Be Edited


Created By: Mai Yang On 06/23/2026 at 02:53 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: RIVERSTONE TERRACE SENIOR LIVING MEMORY CARE
FACILITY NUMBER: 157204131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(g)
87412(g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review.

This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above when requested by the department to review staff files was informed by Administrator that all staff files are not maintained at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/25/2026
Plan of Correction
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Licensee will submit a written statement detailing the steps the facility will take to ensure the requirements for section 87412 are going to be met and ensure that all staff files are kept at the facility by POC due date 07/13/26.
Written statement will be submitted to the Fresno CCL office by POC due date 06/25/26.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 06/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2026


LIC809 (FAS) - (06/04)
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