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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202752
Report Date: 03/25/2024
Date Signed: 03/25/2024 03:41:38 PM


Document Has Been Signed on 03/25/2024 03:41 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:MESSINGER CARE HOMEFACILITY NUMBER:
275202752
ADMINISTRATOR:ESTAMO, JUANITO JRFACILITY TYPE:
740
ADDRESS:3121 MESSINGER DRTELEPHONE:
(831) 883-9386
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY:6CENSUS: 4DATE:
03/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Maria Christine EstamoTIME COMPLETED:
04:00 PM
NARRATIVE
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On 3/25/24, Licensing Program Analyst (LPA) B. Miranda conducted a required unannounced Annual Inspection visit. LPA introduced herself, stated purpose of visit, and was allowed entrance by Staff Maria Christine Estamo. LPA introduced herself, stated purpose of visit, and met with Maria Christine Estamo.

LPA toured the facility inside and out to include entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. All fire exit routes were free and clear of obstructions. LPA observed facility to be clean, free from clutter, and odor free.

Medications are stored in a locked cabinet and inaccessible to residents. Centrally stored medication log was not correctly maintained, deficiency was citatied per California Code of Regulations Tittle 22. Toxins, cleaning supplies, knives and sharp objects are secured.

Facility has 5 bedrooms and 2 bathrooms. Currently resident’s do not share bedrooms. Facility has a capacity of 6 residents, but currently has 4 residents.

Fire extinguishers have been services as of 6/22/23 and are in good standing. Carbon monoxide detector was tested and in working condition. Water temperature was checked in the resident's bathroom and read at 107.3 degree Fahrenheit.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Maria Christine Estamo.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
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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Document Has Been Signed on 03/25/2024 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: MESSINGER CARE HOME
FACILITY NUMBER: 275202752

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(4)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above due to not properly maintaining centrally stored log for residents medication. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/26/2024
Plan of Correction
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Training will be conducted. Facility will provide a statement regarding when training will be completed, Verification of training will be provided to LPA by 4/5/24
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
LIC809 (FAS) - (06/04)
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