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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202077
Report Date: 01/04/2023
Date Signed: 01/09/2023 09:26:10 AM

Document Has Been Signed on 01/09/2023 09:26 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: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: 58DATE:
01/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Administrator- Rita FaatuaiTIME COMPLETED:
11:10 AM
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On 1/4/2023 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to complete an annual inspection. LPA was greeted and allowed entry into the facility. LPA met with Administrator (AD) Rita Faatuai

LPA toured the inside and out of the facility. LPA observed facility as being clean and free from clutter. LPA observed staff interacting with clients.

LPA observed all cleaning supplies in a secured and locked area. AD stated the facility does not have sharps or medication at the facility.

LPA observed fire extinguishers as not being serviced within the past year, fire extinguishers were in good standing. AD provided verified of appointment has been scheduled.

Facility has a 30-day supply of PPE.

LPA did not observe any issues or issue any citations at this time.

Exit interview was completed and a copy of the report was provided to AD Rita Faatuai

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2023
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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