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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202554
Report Date: 02/02/2024
Date Signed: 02/08/2024 08:28:31 AM

Document Has Been Signed on 02/08/2024 08:28 AM - 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) 206-8582
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 4CENSUS: 2DATE:
02/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Designee Administrator Briana GrantTIME COMPLETED:
01:30 PM
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On 2/2/24, Licensing Program Analyst (LPA) B. Miranda conducted an unannounced Annual Required visit. LPA introduced self, stated purpose of visit, and allowed entrance by Designee Administrator Briana Grant.

LPA toured the facility inside and out to include entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. All fire exit routes were free and clear of obstructions. Medications are stored in a locked closet in the hallway. Toxins, cleaning supplies, knives and sharp objects are secured.

Facility has 4 bedrooms and 2.5 bathrooms. The facility has 2 residents with a capacity of 4. Three of the four bedrooms are for residents. Resident’s currently do not share bedrooms. LPA observed residents rooms to be properly furnished.

Fire extinguishers have been services as of 08/08/2023 and are in good standing. Smoke alarms were tested and in working condition. Carbon monoxide detector was tested and in working condition. Water temperature was checked in the kitchen and read at 110.7 degree Fahrenheit.

LPA reviewed resident files which are current and up to date. Sample of staff files were reviewed.

No citations issued per the California Code of Regulations Tittle 22.

Exit interview was conducted and a copy of this report LIC809 was provided to Designee Administrator Briana Grant.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
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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