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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209296
Report Date: 06/09/2023
Date Signed: 06/12/2023 08:33:11 AM

Document Has Been Signed on 06/12/2023 08:33 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:MESCAL HOUSEFACILITY NUMBER:
277209296
ADMINISTRATOR:TINIUS, JEFFREYFACILITY TYPE:
735
ADDRESS:1722 MESCAL STREETTELEPHONE:
(480) 261-7130
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY: 6CENSUS: 0DATE:
06/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Administrator- Jeffrey TiniusTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 6/9/2023 Licensing Program Analyst (LPA) B. Miranda arrived at facility to complete an announced Pre-Licensing visit. LPA met with Administrator (AD) Jeffrey Tinius. LPA toured the facility inside and out. During the tour AD verified all four bedrooms will be occupied by residents. 2 rooms have 2 beds and 2 rooms have single beds. AD verified there will not be live in staff at the facility.
During the tour LPA observed all 4 bedrooms to have adequate furniture, storage, and lighting. Fire extinguisher is current and in good standing. Smoke detectors and carbon monoxide reader are in working conditions. Water temperature was checked in kitchen and read at 114.4 degrees Fahrenheit.
AD explained washer is in the garage and is not accessible to residents for now. AD stated in the future washer and dryer will be accessible once garage is cleaned & cleared. Garage is not listed as a fire exit, only the front and back door are listed as fire clearance exits.

LPA observed the following deficiencies:
1. All trash cans need to have lids.
2. Shower in master bedroom needs to be cleaned
3. All extra items need to be removed from rooms.
4. Window sills need to be cleaned.
5. Container is needed to keep medication in the fridge.
6. Back yard needs to be cleaned.
7. All expired food needs to be discarded.


Pre-licensing is incomplete with deficiencies to be resolved by 6/23/23. A follow up pre licensing LIC 809 will
be generated upon resolution of the deficiencies. Another facility visit will be conducted on 6/23/23 at 1:00 pm.
Exit interview completed and a copy of this report was provided to AD Jeffrey Tinius.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1