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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202747
Report Date: 09/29/2023
Date Signed: 09/29/2023 01:10:58 PM


Document Has Been Signed on 09/29/2023 01:10 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
FRESNO ASC, 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: 24DATE:
09/29/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Facility Medication Technician, Victoria MontoyaTIME COMPLETED:
01:00 PM
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On 9/29/2023, Licensing Program Analyst(LPA) Sarah Hurt arrived unannounced to conduct a case management inspection. The purpose of this inspection was to ensure facility cleanliness, food quality, and resident well being. LPA met with Facility Medication Technician, Victoria Montoya and announced the purpose of the inspection.

LPA Hurt toured the facility including facility kitchen area, resident bedrooms and bathrooms. Bedrooms and bathrooms were clean. LPA observed facility food supply and food service to be of adequate quality and quantity. LPA Hurt observed facility residents having lunch of hamburgers. LPA Hurt observed facility staff preparing residents for happy hour beginning at 1 p.m. LPA Hurt observed kitchen staff preparing fruit trays, and meat with cheese trays for happy hour. LPA Hurt observed caregivers bringing residents to the outside common area for happy hour. LPA observed residents reading, and watching television in their bedrooms. LPA Hurt observed one medication technician, two caregivers, activities staff, housekeeping staff, two kitchen staff, and a maintenance staff working in assisted living and one caregiver in memory care.

No deficiencies were cited during the inspection.

Exit interview conducted with Facility Medication Technician, Victoria Montoya A copy of the report was provided and exit interview conducted.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2023
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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