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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202554
Report Date: 11/09/2024
Date Signed: 11/09/2024 09:14:40 AM

Document Has Been Signed on 11/09/2024 09:14 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/
DIRECTOR:		GRANT, TREVORFACILITY TYPE:
735
ADDRESS:3133 SALINAS AVETELEPHONE:
(831) 206-8582
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 4CENSUS: 2DATE:
11/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:26 AM
MET WITH:Administrator Trevor GrantTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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On 11/9/2024 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct a case management visit. LPA met with Administrator Trevor Grant.

LPA conducted a health and safety check on residents at the facility. LPA observed 2 residents at the facility. LPA observed medication and cleaning supplies to be locked and inaccessible to residents.

LPA observed no deficiencies at this time. LPA previously sent email to Administrator Trevor Grant informing documents needed.


Exit interview was conducted and a copy of this report was provided to Administrator Trevor Grant.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2024
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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