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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209280
Report Date: 05/11/2023
Date Signed: 08/10/2023 09:39:36 AM

Document Has Been Signed on 08/10/2023 09:39 AM - 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:CRESCENT HOUSE, THEFACILITY NUMBER:
277209280
ADMINISTRATOR:GRANT, DAWNFACILITY TYPE:
735
ADDRESS:3017 CRESCENT STTELEPHONE:
(831) 601-8474
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 6CENSUS: 0DATE:
05/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator- Dawn Grant & Licensee- Michelle SchoppTIME COMPLETED:
03:30 PM
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On 5/11/2023 at 12:00 p.m. Licensing Program Analyst (LPA) B. Miranda arrived to the facility for an announced visit to conduct a pre-licensing inspection. LPA met with Licensee Michelle Schopp (Grant), Administrator Dawn Grant, and one oncoming staff member.

Facility currently has no residents with a maximum capacity of 6. Facility is a two story residential facility with 7 bedrooms and 4 bathrooms. 1 room is designated for live in staff and other 6 rooms are for residents. Licensee stated residents will have individual rooms and there will be no shared rooms.

LPA toured the facility inside and out. LPA observed all fire cleared exits to be clear and free from obstruction. LPA observed fire extinguishers to be last serviced 1/4/2023 and are in good standing, upstairs bathroom water temperature read at 112.1 & kitchen water temperature read at 113.1. Locked centralized storage area for medications. First aid kit complete.

All rooms had proper furniture with bed, linen, lighting, drawers, night stand, and closet storage. All bedrooms have blinds for privacy. Sufficient lighting & furnishings in common area. Facility has a common areas for residents to interact with each other. Physical plant is consistent with the facility sketch/floor plan. Smoke & carbon monoxide detectors tested & determined to be operational.

Trash cans with lids for the bathrooms with be purchased and verification will be sent to LPA by end of business day of 5/18/23. No deficiencies were noted at this time.

Component III was also conducted and completed. Exit interview was conducted. Pre-licensing requirements
were met. An exit interview was conducted with Licensee & Administrator. Report signed on-site by Licensee and printed copy provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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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