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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202747
Report Date: 12/28/2022
Date Signed: 12/30/2022 09:27:19 AM


Document Has Been Signed on 12/30/2022 09:27 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 ASSISTED LIVING FACILITY, THEFACILITY NUMBER:
275202747
ADMINISTRATOR:SANDEEP SAINIFACILITY TYPE:
740
ADDRESS:1229 DAVID AVETELEPHONE:
(831) 375-2206
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:49CENSUS: 34DATE:
12/28/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Facility Staff, Loria GarrisonTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit to the facility December 28, 2022 at 12:00 p.m. for a Case Management - Health Checks visit. LPA met with facility staff Loria Garrison and explained the purpose of the visit.

LPA toured the facility in part to include lobby, kitchen, courtyard area, resident bedrooms, bathrooms and common areas.

LPA observed sufficient perishable and Non-perishable food supply. Menu offerings for lunch include stir fry with chicken and vegetables, and rice.. LPA observed 2 kitchen and dining staff. LPA observed 4 Caregivers and, two medication technician, one maintenance employee, and one hospice nurse assisting a resident in room 740. LPA observed residents in the courtyard area chatting, and having coffee. LPA observed several residents being assisted by caregivers.

No deficiencies cited during this visit per the California Code of Regulations Title 22.

Exit interview conducted with Facility Staff Loria Garrison and a copy of this report along with appeals rights left at the facility.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022
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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