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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201286
Report Date: 05/14/2024
Date Signed: 05/16/2024 08:50:44 AM

Document Has Been Signed on 05/16/2024 08:50 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:BROOKDALE MANOR OF CARMELFACILITY NUMBER:
275201286
ADMINISTRATOR/
DIRECTOR:		CYRIL E. TUPINOFACILITY TYPE:
740
ADDRESS:6385 BROOKDALE DRIVETELEPHONE:
(831) 674-8394
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY: 6CENSUS: 1DATE:
05/14/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Julia Galeano - CaregiverTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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On 5/14/2024, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a case management inspection. LPA met with Caregiver Julia Galeano and announced the purpose of the inspection.

LPA conducted the inspection to verify the status of the facility and ensure the health and safety of residents in care. There was one resident and one staff member at the time of inspection. LPA toured the facility inside and outside. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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