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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201364
Report Date: 08/29/2023
Date Signed: 09/21/2023 10:59:03 AM

Document Has Been Signed on 09/21/2023 10:59 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:MARINA HOUSE, THEFACILITY NUMBER:
275201364
ADMINISTRATOR:GRANT, DAWNFACILITY TYPE:
735
ADDRESS:3305 RIO ROADTELEPHONE:
(831) 622-9181
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY: 5CENSUS: 0DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Trevor Grant - Co-LicenseeTIME COMPLETED:
01:30 PM
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On 8/29/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a required annual inspection. LPA met with Co-Licensee Trevor Grant and announced the purpose of the visit.

LPA toured the facility inside an outside. All passageways and exits were clear and free from obstruction. LPA observed smoke and carbon monoxide detectors to be present and operational. Facility fire extinguishers were fully charged. Common areas were clean, adequately lit, and odor free. LPA toured resident bedrooms and bathrooms. Bedrooms were clean, odor free, and contained required minimum furnishings. Bathrooms were clean, odor free, and all fixtures were working properly. Facility has sufficient supply of perishable and non-perishable foodstuffs which were stored properly. Medications were secured in a locked cabinet and appeared to be administered properly.

No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted. This required annual inspection will be continued and completed at a later date.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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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