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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209330
Report Date: 10/04/2023
Date Signed: 10/09/2023 03:34:16 PM


Document Has Been Signed on 10/09/2023 03:34 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: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: DATE:
10/04/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Designee- Ronna Bailey-KrollTIME COMPLETED:
01:30 PM
NARRATIVE
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On 10/4/23 at 11:35 a.m. Licensing Program Analyst B. Miranda arrived to the facility announced to conduct a pre-licensing visit. LPA met with Designee- Ronna Bailey-Kroll and Administrator Carlos Castro. LPA explained the reason for the visit.

LPA toured the facility with Ronna Bailey-Kroll to verify deficiencies were corrected.

The following deficiencies were previously noted and have since been corrected:
  • All trash cans have tight fitted lids.
  • Handle to door in room 6 for emergency exit door has been replaced.
  • Fence has been unlocked from the outside of the gate which is an emergency exit from room 6. Facility will follow-up with fire dept regarding self-latching lock.
  • Alarm has been placed on exit door located in room 6.
  • Staff has been associated with the facility.


Component III was also conducted and completed. Exit interview was conducted. Pre-licensing requirements
were met. An exit interview was conducted with Administrator & Designee. Report signed on-site by Designee- Ronna Bailey-Kroll and printed copy provided.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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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