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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202077
Report Date: 09/26/2023
Date Signed: 09/28/2023 04:55:44 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/01/2023 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230601135723
FACILITY NAME:SVS MARINA ADULT DAY PROGRAMFACILITY NUMBER:
275202077
ADMINISTRATOR:RITA FAATUAIFACILITY TYPE:
775
ADDRESS:330 RESERVATION RD. STE. DTELEPHONE:
(831) 582-2961
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY:60CENSUS: 34DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Administrator- RITA FAATUAI TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff do not ensure facility is kept in clean, safe, sanitary conditions for clients
INVESTIGATION FINDINGS:
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On 9/26/23 at 10:05 a.m. Licensing Program Analyst B. Miranda arrived at the facility unannounced to deliver the finding for the allegations listed above. LPA introduced herself and explained the reason for the visit. Administrator (AD) RITA FAATUAI was contacted.
1. The Department investigated the allegation: Staff do not ensure facility is kept in clean, safe, sanitary conditions for clients. LPA toured the facility on 6/5/23 and found the men's bathroom to have a pungent urine smell. The floors also seemed to be sticky, LPA was unable to find the reason for the floor to be sticky, and staff was able to identify the reason.
Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 3, are being cited on the attached LIC 9099D.
Exit interview was conducted and a copy of this report LIC9099, LIC9099D, and appeal rights were printed and given to administrator RITA FAATUAI
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20230601135723
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SVS MARINA ADULT DAY PROGRAM
FACILITY NUMBER: 275202077
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2023
Section Cited
CCR
82087(a)
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82087 Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement is not met as evidenced by:
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Staff will be proactive. Staff have been assigned to clean bathroom throughout the day. Staff will clean after accident in bathroom. Administrator will provide procedure in writing to LPA.
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Based on observation and interviews licensee failed to keep the facility safe, sanitiary, and in good repair at all times. LPA observed the men's bathroom to have a pungent urine odor and sticky floors. This poses a potential health, safety, or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2