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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202358
Report Date: 06/23/2023
Date Signed: 06/23/2023 02:19:28 PM


Document Has Been Signed on 06/23/2023 02:19 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: 76DATE:
06/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kellie Shearer - Executive DirectorTIME COMPLETED:
02:30 PM
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On 6/23/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual Inspection. LPA met with acting Administrator Kellie Shearer and announced the purpose of the visit. Administrator Certification is current.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Fire extinguishers were recently serviced and facility has a sprinkler system. Last emergency drill was conducted 6/3/2023 and facility staff maintain records of monthly drills. LPA toured the facility kitchen and observed an adequate supply of perishable and non-perishable foodstuffs. Kitchen and all common areas were clean, well-lit, and odor-free. Facility had adequate supply of emergency food and first aid supplies. LPA reviewed emergency-disaster plan and back-up generator. LPA toured a sample of resident bedrooms and bathrooms, which were observed to be clean, with all fixtures and appliances functioning properly. Bathrooms were clean and were equipped with required grab-bars and non-skid mats. LPA toured facility memory care unit. LPA observed centrally stored medications in assisted living and memory care to be properly stored and secured, and medications appeared to be administered properly. LPA reviewed a sample of resident and staff files. LPA requested the following files to be provided by 7/7/2023: LIC 500, LIC 308, LIC 9020a.

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: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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