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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202077
Report Date: 10/24/2024
Date Signed: 10/24/2024 12:20:23 PM

Document Has Been Signed on 10/24/2024 12:20 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:SVS MARINA ADULT DAY PROGRAMFACILITY NUMBER:
275202077
ADMINISTRATOR/
DIRECTOR:		RITA FAATUAIFACILITY TYPE:
775
ADDRESS:330 RESERVATION RD. STE. DTELEPHONE:
(831) 582-2961
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 60CENSUS: 44DATE:
10/24/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:04 AM
MET WITH:Administrator Rita FaatuaiTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 10/24/24 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to continue and complete the annual inspection. LPA met with Administrator Rita Faatuai.
LPA observe staff and clients interacting with one another. All emergency exits were clear and free from obstruction. LPA observed disaster plan to be completed, but will need to be updated with additional detailed information.
Facility is currently licensed for a capacity of 60 with a current census of 44. Current staff is totaling 15 today, including 1:1 staff needed for clients who require a 1:1 staff support.
LPA observed carbon monoxide detector to be tested and in working condition, fire extinguisher last serviced 2/27/24 in good stand with charge. Medication is not kept at the facility and food is not prepared for client's at the facility.
Regarding physical plant LPA observed the following:
  • Various electrical wall covers broken throughout the facility
  • Insects and other debris in window sills
  • Oven in lunch room needs to be cleaned
  • Drawers in the lunch room has debris
  • Under the sink needs to be cleaned in lunch room
  • Movie room have various stains in the carpet

Water temperature was checked in the women's bathroom and lunch room which did not reach a minimum of 105 degrees Fahrenheit.
Administrator was not able to provide verification of staff meeting the required 8 hours of annual training.
Citations issued under Title 22 on LIC809D
Exit interview was conducted and a copy of this reported LIC809, LIC809D, and appeal rights were provided to Administrator Rita Faataui
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 10/24/2024 12:20 PM - It Cannot Be Edited


Created By: Brianna Miranda On 10/24/2024 at 11:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SVS MARINA ADULT DAY PROGRAM
FACILITY NUMBER: 275202077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA tested the water temperature in the women's bathroom and lunch room which did not reach a minimum of 105 degrees Fahrenheit.
POC Due Date: 10/25/2024
Plan of Correction
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Administrator will have water heater adjusted and verification sent to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Brianna Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/24/2024 12:20 PM - It Cannot Be Edited


Created By: Brianna Miranda On 10/24/2024 at 11:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SVS MARINA ADULT DAY PROGRAM
FACILITY NUMBER: 275202077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065.1(d)(1)
Personnel Qualifications and Duties
(1) Direct care staff shall receive a minimum of 8 hours a year of training, documented.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2024
Plan of Correction
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Required training will be conducted to complete the 8 hours and verification will be sent to LPA.
Type B
Section Cited
CCR
82087(a)
(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:
Deficient Practice Statement
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Based on observation & interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed the following: Various electrical wall covers broken throughout the facility, Insects and other debris in window sills, Oven in lunch room needing to be cleaned, Drawers in the lunch room has debris, Under the sink needs to be cleaned in lunch room, Movie room have various stains in the carpet.
POC Due Date: 11/07/2024
Plan of Correction
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Administrator will make corrections and send picture verification to LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Brianna Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024


LIC809 (FAS) - (06/04)
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