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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202746
Report Date: 12/09/2022
Date Signed: 12/13/2022 11:39:32 AM


Document Has Been Signed on 12/13/2022 11:39 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:DEL MONTE MEMORY CARE FACILITYFACILITY NUMBER:
275202746
ADMINISTRATOR:ERNEST GIBSONFACILITY TYPE:
740
ADDRESS:1221 DAVID AVETELEPHONE:
(831) 375-2206
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:6CENSUS: 4DATE:
12/09/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Anu SaniTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility on 12/09/2022 unannounced to conduct a Case Management - Health Checks visit.. LPA Hurt met with Licensee Anu Sani and explained the purpose of today's visit.Document Link Icon

LPA Hurt received an Incident Report dated 12/07/2022 documenting Resident 1 was taken to the dermatologist after staff noticed a rash on their body. Licensee stated Resident 1 is in a room alone, but there is a common area that all rooms in that area lead to. Facility staff has contacted the Primary Care Physician for the other three residents in the memory care that share the same common area. Licensee stated all other residents in the area were prescribed a cream for the treatment of scabies. The other three residents are showing signs of a rash. Resident 1 is the only one with confirmed diagnosis of scabies. On 12/07/2022 facility memory care was sanitized, laundry removed to be sanitized, and all residents showered, and all furniture was cleaned.. Licensee stated the facility staff is having an In-Service Training on scabies on 12/09/2022 along with a quiz to ensure all staff is aware of the care plan. The facility staff has not updated Resident 1's care plan as of today.

The facility staff has not yet notified Local County Health Department as this is not a confirmed outbreak.

No deficiencies were cited per Title 22 Regulations. Exit interview conducted with Licensee Anu Sandeep, and a copy of this report was left at the facility along with appeals rights provided.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
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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