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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209296
Report Date: 11/09/2024
Date Signed: 11/09/2024 01:32:08 PM

Document Has Been Signed on 11/09/2024 01:32 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: 1DATE:
11/09/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:47 AM
MET WITH:Administrator Jeffrey TiniusTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 11/9/24 Licensing Program Analyst (LPA) B. Miranda arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced herself, stated the purpose of the visit, and was granted entry to the facility. LPA met with Licensee/Administrator Jeffrey Tinius.

LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPA observed the facility to be at a comfortable temperature, clean and odor free. Facility is free of debris, in good repair, and no passageways are obstructed and fire hazards were observed. Common areas were properly furnished and well-lit throughout.

Facility capacity is 6, with a current census of 1. Facility has 4 bedrooms and 2 bathrooms. At this time residents do not share bedrooms, but at full capacity 2 rooms will be shared. Fire extinguishers are set to be serviced next week and are in good standing with charge. Smoke detectors and carbon monoxide detectors were tested and are in working condition. Water temperature was checked in the hallway bathroom and read at 109.1 degrees Fahrenheit.

Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Knives, cleaning supplies, and toxins were observed to be locked and inaccessible to residents.

LPA reviewed sample of staff and resident files. Resident files are still be completed due to resident moving in on 11/8/24.
Under California Code of Regulations Title 22 no deficiencies were observed, and no citations were issued at this time.
Exit interview was conducted and a copy of this report LIC809 was provided to Administrator Jeffrey Tinius.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2024
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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