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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202358
Report Date: 12/07/2022
Date Signed: 12/07/2022 06:08:14 PM


Document Has Been Signed on 12/07/2022 06:08 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:SUNRISE ASSISTED LIVING OF MONTEREYFACILITY NUMBER:
275202358
ADMINISTRATOR:PAUL L. HARRISONFACILITY TYPE:
740
ADDRESS:1110 CASS STTELEPHONE:
(831) 643-2400
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:112CENSUS: 73DATE:
12/07/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Asha Prasad, Business Office CoordinatorTIME COMPLETED:
06:30 PM
NARRATIVE
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On 12/7/22 at 3:30 PM, Licensing Program Analyst (LPA) Malia Thao conducted a case management - deficiencies inspection after making observations during complaint inspection for complaint #24-AS-20221130134408. LPA met with Business Office Coordinator (BOC) Asha Prasad. Regional Director Herman Marquez was available by telephone.

LPA found that S1 and S2 was present and working in the facility. S1 had worked previously in October 2022 for unknown number of days and came back to work on 12/5/22 through today. S2 had been working in the facility since 12/5/22. S1 did not have criminal record clearance and admitted S1 had not completed fingerprint live scan. S2 had criminal record clearance but a transfer of criminal record clearance to this facility was not completed.

Deficiencies are being cited based on LPA observation and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. Civil penalties are being assessed in the amount of $100 per day, for a maximum of 5 days, for a total of $500 for S1 and $100 per day, for 3 days, for a total of $300 for S2. See LIC421BGs for more details.

An exit interview was conducted and Plans of Corrections were reviewed and developed with Regional Director via telephone. A copy of this report and appeal rights were given to Business Office Coordinator Asha Prasad, whose signature on this form confirms receipt of these documents.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
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 2


Document Has Been Signed on 12/07/2022 06:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: SUNRISE ASSISTED LIVING OF MONTEREY
FACILITY NUMBER: 275202358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/08/2022
Section Cited

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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working...in a licensed facility: (1) Obtain a California clearance or a criminal record exemption...
This requirement is not met as evidenced by:
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LPA found that S1 was present and working in the facility. S1 had been working in the facility since 12/5/22. S1 did not have criminal record clearance and admitted S1 had not yet completed fingerprint live scan, which poses an immediate health, safety, or personal rights risk to residents in care.
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Type A
12/07/2022
Section Cited

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87355Criminal Record Clearance
(e) All individuals subject to a criminal record review...shall prior to working...in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or

This requirement is not met as evidenced by:
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LPA found that S2 was present and working in the facility. S2 had been working in the facility since 12/5/22. S2 had criminal record clearance but a transfer of criminal record clearance to this facility was not completed, which poses an immediate 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.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2