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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209330
Report Date: 09/28/2023
Date Signed: 10/04/2023 11:51:14 AM


Document Has Been Signed on 10/04/2023 11:51 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:ABOUT CARE ASSISTED LIVING CENTERFACILITY NUMBER:
277209330
ADMINISTRATOR:CASTRO, CARLOSFACILITY TYPE:
740
ADDRESS:1201 LA SALLE AVETELEPHONE:
(831) 324-4113
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY:15CENSUS: 12DATE:
09/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Staff Ronna Bailey-KrollTIME COMPLETED:
02:00 PM
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On 9/28/23 at 10:57 a.m. Licensing Program Analyst B. Miranda arrived to the facility unannounced to conduct a pre-licensing visit. LPA met with Ronna Bailey-Kroll and explained the reason for the visit. Administrator Carlos Castro was contacted and was not able to come to the facility. Carlos gave permission for Ronna to conduct the tour.

Physical plant toured. Regulations reviewed. Facility is clean, free from clutter, and odor free. Interior & exterior passageways free of obstructions. Items that could pose a danger, such as disinfectants, cleaning solutions, etc., are inaccessible. Sufficient lighting & furnishings in common area. Facility has a common area for residents interact with each other. Locked centralized storage area for medications. First aid kit complete. LPA observed water temperature in two bathrooms to read at 116.2 & 116.7 degrees F. Physical plant is consistent with the facility sketch/floor plan. Fire extinguisher recently served and in good standing.
LPA will follow up with report received for Inspection Report from Seaside Fire Dept regarding smoke detectors and carbon monoxide readers.

LPA observed the following deficiencies:
All trash can must have tight fitted lids.
Emergency exit door in room six needs to have handle replaced.
Fence needs to be unlocked which is an emergency exit from room 6.
Alarm needs to be placed on exit door located in room 6.
Staff needs to be associated to the facility.


Pre-licensing is incomplete with deficiencies to be resolved by 10/4/23. A follow up pre licensing LIC 809 will be generated upon resolution of the deficiencies. Per request of the facility follow-up visit will be conducted 10/4/23.

Exit interview conducted and a copy of this report was provided to Ronna Bailey-Kroll

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
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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