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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275294362
Report Date: 02/02/2023
Date Signed: 03/21/2023 03:24:12 PM


Document Has Been Signed on 03/21/2023 03:24 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:SWANER GUEST HOMEFACILITY NUMBER:
275294362
ADMINISTRATOR:ROSARIO MAGSAMBOLFACILITY TYPE:
740
ADDRESS:18615 SWANER AVENUETELEPHONE:
(831) 449-9379
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:6CENSUS: 5DATE:
02/02/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Rosario MagsambolTIME COMPLETED:
11:15 PM
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An informal conference was conducted today 02/02/2023 in the Fresno Regional Office. The purpose of this informal conference meeting is to discuss the facilities multiple Type A citing’s during the recent Annual Inspection. Present in the meeting is Licensing Program Manager Brenda Chan, Licensing Program Analyst Sarah Hurt, Licensee/Administrator Mathew Magsambol, and Licensee/ Administrator Rosario Magsambol.

Issues discussed during the meeting were:
· Food service
· Facility is not clean and in good repair
· Facility water temperature is too hot
· Facility room temperatures below required regulation minimum of 68 degrees.


The facility has stated they will do the following to achieve continued and substantial compliance:
Conduct frequent training with facility staff related to daily facility operating tasks
Conduct Food Service Requirements training with facility staff
· Frequently check facilities water temperature.
· Provide updated floor plan to include one storage room (store clutter)
· Ensure the facility, and all resident bedrooms are clean and not full of clutter.
Ensure the facility room temperature is within required regulation temperature. (minimum of 68 degrees)
Utilize online Resources provided to ensure facility remains in compliance

Continued on 809C.. .

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
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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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: SWANER GUEST HOME
FACILITY NUMBER: 275294362
VISIT DATE: 02/02/2023
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Licensing Program Manger Brenda Chan offered several online resources including Technical Support Program (TSP), Self-Assessment Guide, Medication Guide, and HCO Resources offered by Department of Social Services to assist Licensee’s Rosario Magsambol, and Mathew Magsambol with coming into compliance

Licensee Rosario Magsambol agreed to submit an updated LIC 308, and LIC 500 to Licensing by 02/09/2023. Licensee Rosario Magsambol agreed to research the TSP program and consider enrolling. Licensee Rosario Magsambol agreed to submit a written plan to Licensing on how they will oversee the daily operations of the facility, monitor the quality and amount of staff present at the facility, and improve daily operations of the facility by 02/09/2023.

Exit interview conducted and a copy of this report provided to Licensee/ Administrator Rosario Magsambol.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
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