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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201364
Report Date: 09/21/2023
Date Signed: 09/21/2023 11:44:09 AM

Document Has Been Signed on 09/21/2023 11:44 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:
09/21/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Dawn Grant - AdministratorTIME COMPLETED:
12:00 PM
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On 9/21/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a required annual inspection. LPA met with Administrator Dawn Grant and announced the purpose of the visit. This inspection was a continuation of a required annual inspection which was me begun on 8/29/2023.

During inspection LPA reviewed staff and client files. All files contained required records. LPA verified facility surety bond is current. LPA reviewed facility Emergency DIsaster plan. LPA reviewed Resident Personal and Incidental money. No deficiencies were cited during the inspection. A copy of the reports were provided and exit interview conducted.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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