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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011440823
Report Date: 05/15/2024
Date Signed: 05/15/2024 05:45:22 PM

Document Has Been Signed on 05/15/2024 05:45 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
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:
05/15/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Rosario Mababa, CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 05/15/2024 at 10:55 AM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct Proof of Correction (POC) visit. LPA met with Caregiver, Rosario "Chary" Mababa, and informed the reason for visit. Chary phoned the Administrator, Robert T. Laguna to inform. Robert was unavailable to come to the facility.

On 04/10/2024 LPA L. Alexander conducted an Annual Inspection in which the following deficiencies were not cleared by POC due date of 04/24/24 and 05/08/24. LPA assessed civil penalties during POC Visit on 04/26/24 and advised the Administrator, Robert T. Laguna that assessed civil penalties will continue until deficiencies are corrected.

Continued Civil Penalties Assessed:
  1. CCR 80020(c) = 3 Days x $100 = $300
  2. CCR 80075 (e)(2)(A)(B) = 3 Days x $100 = $300
  3. HSC 1565(d) = 5 Days x $100 = $500

Facility has the following deficiencies that was not cleared by 05/08/2024:

  1. CCR 80066(a)(10) = 7 Days x $100 = $700

Civil Penalties in the total amount of $1,8000.00 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: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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