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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202260
Report Date: 10/12/2023
Date Signed: 10/12/2023 12:13:58 PM


Document Has Been Signed on 10/12/2023 12:13 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:ARCHWAY OF CARMELFACILITY NUMBER:
275202260
ADMINISTRATOR:CYRIL TUPINOFACILITY TYPE:
740
ADDRESS:3262 TAYLOR ROADTELEPHONE:
(831) 269-4164
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:6CENSUS: 5DATE:
10/12/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Cyril Tupino - Administrator TIME COMPLETED:
12:20 PM
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On 10/12/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Proof of Correction inspection. LPA met with Administrator Cyril Tupino and announced the purpose of the inspection. This visit was conducted to verify that the Administrator had followed the agreed upon plan of correction for the deficiency which was cited on 8/29/2023.

LPA toured the facility. LPA reviewed staff training logs and medication administration records. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted with Administrator.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
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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