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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270708207
Report Date: 11/14/2024
Date Signed: 11/14/2024 05:54:11 PM

Document Has Been Signed on 11/14/2024 05:54 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:CARMEL VILLAFACILITY NUMBER:
270708207
ADMINISTRATOR/
DIRECTOR:
KATHLEEN S. VORISFACILITY TYPE:
740
ADDRESS:26635 PANCHO WAYTELEPHONE:
(831) 625-9394
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Administrator Dina WissingerTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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On 11/14/2024, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. LPA toured the facility with Licensee Kathleen Voris. Administrator Dina Wissinger was notified and available during the visit.

The facility was observed to be at a comfortable temperature, of 77 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. During the visit the facility residents were out at day program. Department phone number and infection prevention information signs were posted thought the facility.

Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed.

A fire extinguisher was observed with service date of 01/15/2024. Private six residents’ bedroom observed to be at comfortable temperatures. The bathroom’s water temperature was tested and recorded reading of 105 degrees F.

Medications records storage observed to be locked in a cabinet in a . Cleaning supplies were observed to be in a locked cabinet in the storage it the laundry room. An outdoor seating area was observed operational for residents in care.

LPA reviewed staff and residents’ files. No deficiencies were observed and cited during this visit.

Exit interview conducted. A report was signed, and a copy of this report was provided for facility records.
Brenda ChanTELEPHONE: (650) 266-8889
Vadim GorbanTELEPHONE: (559) 243-8080
DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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