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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202554
Report Date: 02/27/2023
Date Signed: 02/28/2023 03:59:59 PM

Document Has Been Signed on 02/28/2023 03:59 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:NEVILLE HOUSE, THEFACILITY NUMBER:
275202554
ADMINISTRATOR:GRANT, TREVORFACILITY TYPE:
735
ADDRESS:3133 SALINAS AVETELEPHONE:
(831) 601-8474
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 4CENSUS: 3DATE:
02/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Administrator- Briana & Trevor GrantTIME COMPLETED:
04:45 PM
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On 2/27/2023, Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct the required Annual Infection Control Inspection. LPA was greeted by S1 and allowed entry into the facility. Administrator (AD) Briana & Trevor Grant were contacted and arrived at a later time.

LPA toured the facility inside and out. Facility has 4 bedrooms and 2 bathrooms. Facility has 3 residents with their own rooms and one community bathroom. LPA observed 2 days worth of perishable food items and 7 days worth non-perishable food items.

Water temperature in Kitchen was taken and read at 113.4 degrees. Fire extinguisher was observed in good standing and last serviced 8/25/22.

LPA observed kitchen to be clean and free from clutter. Medication is locked and inaccessible to residents, medication log was reviewed. Residents files were also reviewed.

LPA observed exits as clean and free from obstructions.
LPA observed bathroom as clean and free from clutter, chemicals were locked and inaccessible to residents.
LPA observed garage which is inaccessible to residents.


No deficiencies were found at this time and no citations were issued.

Exit interview was completed and a copy of LIC809 was emailed to AD Briana & Trevor Grant.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023
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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