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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011440823
Report Date: 04/26/2024
Date Signed: 04/26/2024 11:12:19 AM

Document Has Been Signed on 04/26/2024 11:12 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BESCO GARDENFACILITY NUMBER:
011440823
ADMINISTRATOR/
DIRECTOR:		LAGUNA, ROBERT I.FACILITY TYPE:
735
ADDRESS:40242 CROCKETT STREETTELEPHONE:
(510) 226-8813
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 6CENSUS: 2DATE:
04/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Rosario Mababa, CaregiverTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 04/26/2024 at 9:25 AM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct Proof of Correction (POC) visit. LPA met with Caregiver, Rosario Mababa, and informed the reason for visit. Rosario phoned the Licensee/Administrator, Robert Laguna to inform.

On 04/10/2024, LPA conducted an Annual visit in which deficiencies were cited. The POC due date was 04/11/2024 for Type A deficiencies and for the Type B deficiencies the POC due dates were 04/17/24, 04/24/24 and 05/08/24. Administrator failed to submit the POCs by the 04/17/24 and 04/24/24 due dates.

Facility has the following deficiencies that was not cleared:
  1. CCR 80020(c) $100 x 2 = $200.00
  2. CCR 80076(a)(1) $100 x 9 = $900.00
  3. CCR 80075(e)(2)(A)(B) $100 x 9 = $900.00
  4. CCR 87203 $100 x 9 = $900.00
  5. CCR 85064(e)(f) $100 X 9 = $900.00
  6. HSC 1565(d) $100 x 9 = $900.00

Civil Penalties in the total amount of $4,700.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing daily civil penalties until deficiencies is corrected.

Exit interview conducted. A copy of this report, appeal rights, and LIC421FC provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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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