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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209241
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:43:32 AM

Document Has Been Signed on 12/11/2024 11:43 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:PACIFIC GROVE SENIOR LIVINGFACILITY NUMBER:
277209241
ADMINISTRATOR/
DIRECTOR:		JESSICA SANCHEZFACILITY TYPE:
741
ADDRESS:551 GIBSON AVENUETELEPHONE:
(831) 657-5200
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY: 150CENSUS: 74DATE:
12/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:48 AM
MET WITH:Administrator Jessica SanchezTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 12/11/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to collect original report and provide amended report. LPA met with Administrator (AD) Jessica Sanchez who was at the facility.

LPA explained the reason for the visit was to amend the original report, collect the original report, and provide a copy of the amended report. No tour of the facility was completed due to the sole purpose of the visit was to provide amended report.

Exit interview conducted, original report was collected, and a copy of the amended report was emailed to Administrator.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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