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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209296
Report Date: 07/27/2024
Date Signed: 07/28/2024 11:49:31 PM

Document Has Been Signed on 07/28/2024 11:49 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:MESCAL HOUSEFACILITY NUMBER:
277209296
ADMINISTRATOR/
DIRECTOR:		TINIUS, JEFFREYFACILITY TYPE:
735
ADDRESS:1722 MESCAL STREETTELEPHONE:
(480) 261-7130
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY: 6CENSUS: 0DATE:
07/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:00 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
05:06 PM
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On 7/2/7/24 Licensing Program (LPA) arrived at the facility unannounced to conduct an annual inspection.
LPA knocked and rand the doorbell but there was no answer.

LPA will attempt to conduct the annual inspection on a different day.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2024
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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