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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201364
Report Date: 11/08/2024
Date Signed: 11/08/2024 03:12:47 PM

Document Has Been Signed on 11/08/2024 03:12 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:MARINA HOUSE, THEFACILITY NUMBER:
275201364
ADMINISTRATOR/
DIRECTOR:		GRANT, DAWNFACILITY TYPE:
735
ADDRESS:3305 RIO ROADTELEPHONE:
(831) 622-9181
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY: 5CENSUS: DATE:
11/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:02 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 11/8/24 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a case management. LPA met with Trevor Grant.


LPA requested current/recent LIC308, LIC200 (if there is a more current), and verification of control of property. Trevor will provide current verification today. Trevor explained other documents can be provided once he is able to contact his attorney. The attorney is not available until after 11/13/2024.

Exit interview was conducted and a copy of this report was provided to Trevor Grant.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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