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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209489
Report Date: 09/17/2024
Date Signed: 09/20/2024 06:27:09 AM


Document Has Been Signed on 09/20/2024 06:27 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:COTTAGES OF CARMELFACILITY NUMBER:
277209489
ADMINISTRATOR:ESTRELLADO, JULE MAYFACILITY TYPE:
740
ADDRESS:26245 CARMEL RANCHO BLVD.TELEPHONE:
(831) 620-1800
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:78CENSUS: 57DATE:
09/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Administrator Julie May EstrelladoTIME COMPLETED:
01:30 PM
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On 09/17/2024, Licensing Program Analyst (LPA) V Gorban conducted an announced Pre-licensing visit. LPA identified himself and discussed the purpose of the visit. LPA conducted the inspection with the facility Administrator (AD) Julie Estrellado.

An inside and outside tour of the facility was conducted with AD. Home is fire cleared for 74 (seventy four) non-ambulatory and 4 (four) bed ridden residents. The facility provides 16 private rooms in memory care and 58 private rooms on assisted living portion of the facility. Resident’s each room have adequate furnishings and lighting and all the required furnishings. Mattress and linen appeared to be in good condition. LPA observed a supply of extra bed linens. Bathrooms were properly equipped, and trash cans had a fitting lid.


Hot water temperature was observed to be 109 degrees F. Kitchen observed to have dishes, plates, utensils. Sharps/knives and medications are locked in the kitchen. Groceries are delivered to the facility every other day by Sysco food company. Cleaning supplies are stored. First aid kit contains all the required items. The facility equipped with fire pool boxes throughout. Fire extinguishers are present and was serviced on 06/27/2024. Smoke detectors and carbon monoxide are combined in one unit and were operating properly.

Outside of the facility toured. Exits open free of obstruction. Gate is self-latching. No outside hazards were observed. All required postings are posted. Facility phone number will be 831-620-1800.

Component III conducted during pre-licensing inspection.


No deficiencies were observed during this inspection. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

Pre-Licensing is complete, and this facility has no deficiencies.

Exit interview conducted, report is signed and copy of the report provided to the Administrator.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024
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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