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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270708224
Report Date: 01/04/2023
Date Signed: 01/10/2023 01:52:20 PM


Document Has Been Signed on 01/10/2023 01:52 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:CANTERBURY WOODSFACILITY NUMBER:
270708224
ADMINISTRATOR:ELVYRA ABAREFACILITY TYPE:
741
ADDRESS:651 SINEX AVENUETELEPHONE:
(831) 373-3111
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:190CENSUS: 140DATE:
01/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Administrator- Elvyra AbareTIME COMPLETED:
03:10 PM
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On 1/4/2023 at 1:34 p.m. Licensing Program Analyst (LPA) B. Miranda conducted an unannounced Case Management visit. LPA met with Administrator (AD) Elvyra Abare. LPA was greeted and allowed entry into the facility.

LPA did a small tour of the facility while going to R1's room.

LPA observed R1's room and interviewed R1. Interview will be entered on LIC812. LPA also interviewed AD and obtained R1's LIC 600.


No citations issued per the California Code of Regulations Tittle 22.

LPA reviewed report with AD Elvyra Abare and a copy of this report provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2023
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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