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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270708224
Report Date: 12/15/2023
Date Signed: 12/15/2023 09:40:25 AM


Document Has Been Signed on 12/15/2023 09:40 AM - 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: 125DATE:
12/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Elvyra Abare - Executive DirectorTIME COMPLETED:
09:50 AM
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On 12/15/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Plan of Correction inspection. LPA met with Executive Director Elvyra Abare and announced the purpose of the inspection.

During the inspection, LPA toured the facility. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023
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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