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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202747
Report Date: 01/23/2023
Date Signed: 02/21/2023 12:29:19 PM


Document Has Been Signed on 02/21/2023 12:29 PM - 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: 28DATE:
01/23/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
07:00 PM
MET WITH:Administrator, Robbie Cantiori TIME COMPLETED:
09:15 PM
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Licensing Program Analyst (LPA) Sarah Hurt and Licensing Program Manager (LPM) Brenda Chan conducted an unannounced visit to the facility January 23, 2023 at 07:00 p.m. for a Case Management - Health Checks visit. LPA and LPM met with facility Administrator Robbie Cantiori and explained the purpose of the visit.

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



LPA Hurt and LPM Chan confirmed sufficient perishable and Non-perishable food supply. LPA Hurt and LPM Chan observed 2 caregivers in assisted living, one caregiver in memory care, and Administrator Robbie Cantiori on site to assist. LPA Hurt and LPM Chan observed residents watching movies in common area, and preparing for bed.

LPA Hurt and LPM Chan collected Physician's Reports and Needs and Services plans for 6 random facility residents.

No deficiencies Cited today Per Title 22 Regulations.

Exit Interview Conducted with Administrator Robbie Cantori, and a copy of this report along with appeals rights were provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
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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