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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201839
Report Date: 04/25/2023
Date Signed: 04/26/2023 08:56:14 AM


Document Has Been Signed on 04/26/2023 08:56 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:EL CAMINO REAL MANORFACILITY NUMBER:
275201839
ADMINISTRATOR:CYRIL E. TUPINOFACILITY TYPE:
740
ADDRESS:3250 VISTA DEL CAMINO CIRCLETELEPHONE:
(831) 384-0390
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY:6CENSUS: 6DATE:
04/25/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator Martin UretaTIME COMPLETED:
03:15 PM
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On 4/25/2023 at 2:45 p.m. Licensing Program Analysts B. Miranda and S. Doucette arrived to the facility unannounced to conduct a case management. LPA meet with the Administrator Martin Ureta.

Case management was conducted due to double dead bolt possibly not being replaced since the annual visit. LPAs tour the facility to verify fire clearance exits were clear and free from obstruction. LPAs observed the front door which no longer uses the double dead bolt, and back sliding door which no longer uses a stick to lock.

Deficiencies were corrected and no citations were issued.

Exit interview completed, copies of LIC809 given to Administrator Martin.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023
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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