<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209241
Report Date: 05/25/2023
Date Signed: 06/01/2023 09:34:54 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/23/2023 and conducted by Evaluator David Ayers
COMPLAINT CONTROL NUMBER: 24-AS-20230523092746
FACILITY NAME:PACIFIC GROVE SENIOR LIVINGFACILITY NUMBER:
277209241
ADMINISTRATOR:FAY, SHARONFACILITY TYPE:
741
ADDRESS:551 GIBSON AVENUETELEPHONE:
(831) 657-5200
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:150CENSUS: 63DATE:
05/25/2023
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Paul Harrison-Executive Director TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Emergency lights in stairwell are in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/25/2023, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct a initial 10-day complaint inspection. LPA met with Executive Director Paul Harrison and announced the purpose of the visit.

During a previous visit, LPA reviewed the facility Emergency Disaster Plan, conducted interviews, and toured the facility. LPA observed the facility generator and reviewed emergency procedures with facility maintenance team and administration. During recent storms and power outages, facility staff applied their emergency disaster plan, which has been in place in its current format since November 2022. mobile emergency lighting was placed in facility stairwells during a power outage which occurred in March 2023. The allegations are Unsubstantiated. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted with Executive Director.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 1