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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202698
Report Date: 04/27/2023
Date Signed: 05/04/2023 08:52:47 AM

Document Has Been Signed on 05/04/2023 08:52 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:BRIDGE HOUSEFACILITY NUMBER:
275202698
ADMINISTRATOR:MARISOL GUTIERREZ-ALVAREZFACILITY TYPE:
772
ADDRESS:601/603 BAYONET CIRCLETELEPHONE:
(831) 647-3000
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 14CENSUS: 13DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator- Marisol Gutierrez-AlvarezTIME COMPLETED:
03:30 PM
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On 4/27/2023 at 11:00 a.m. Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct an annual inspection. LPA was allowed into the facility by staff member, Administrator Marisol Gutierrez-Alvarez was contacted arrived at the facility shortly after. LPA explained the reason for the visit.

Facility was toured inside and out. Facility currently has 13 residents. There are 9 bedrooms and 3 full size bathrooms that are shared. LPA observed fires exits to be clear and free from obstructions, water temperature in the bathroom read as 113.8 degrees Fahrenheit, fire extinguishers were last service 3/2/2023 and are in good standing condition. All cleaning supplies were inaccessible and stored in locked cabinet.

LPA observed kitchen to be free from clutter with 7 days of non-perishable food items, and 2 days worth of perishable food items. LPA did not observe knives or other sharps to be accessible to residents.
LPA observed a sample of resident's rooms to have proper furniture, adequate storage, and proper bedding.
LPA reviewed a sample of resident and employee files, training log was current, and fire drill log was up today.
LPA observed medication room where medication is kept, lock, and inaccessible to residents. LPA reviewed a sample of resident's medication, MARs, and Centrally Stored Medication Log.

LPA will follow-up with Administrator regarding Certificate.


Exit interview was completed. LIC 809 was printed and provided to the Administrator Marisol Gutierrez-Alvarez.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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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