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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275200516
Report Date: 07/19/2023
Date Signed: 07/19/2023 02:27:53 PM


Document Has Been Signed on 07/19/2023 02:27 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:MAGALLANES REST HOME #2FACILITY NUMBER:
275200516
ADMINISTRATOR:MAGALLANES, LYDIA M.FACILITY TYPE:
740
ADDRESS:3271 MARINA DRIVETELEPHONE:
(831) 521-5799
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY:2CENSUS: 0DATE:
07/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Administrator- Lydia MagallanesTIME COMPLETED:
03:00 PM
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On 7/19/2023 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct an unannounced visit. Administrator previously stated they mailed their license to Sacramento Regional Office and will not longer have the facility licensed. Administrator Lydia opened the facility and LPA toured the facility. LPA observed there are no current residents living at the facility. Administrator stated the facility did not have any residents living at the facility since 2011.

Exit interview was conducted and a copy of this report was provided to Administrator Lydia.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023
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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