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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200006
Report Date: 02/27/2025
Date Signed: 02/27/2025 02:09:02 PM

Document Has Been Signed on 02/27/2025 02:09 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:SANTA CRUZ RESIDENTIAL CARE FACILITYFACILITY NUMBER:
019200006
ADMINISTRATOR/
DIRECTOR:		FRAINO, ANTHONYFACILITY TYPE:
735
ADDRESS:31360 SANTA CRUZ WAYTELEPHONE:
(510) 487-3905
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 4DATE:
02/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Jorge SayganTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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At around 11:30 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection and met with staff Jorge Saygan. LPA explained to Saygan the purpose of the visit. The Administrator was informed about the visit.

During the visit, LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, dining, garage and outside areas. The facility is a Level 4i home vendorized by the Regional Center of the East Bay (RCEB). LPA observed a fire extinguisher in the kitchen that appeared full and was last serviced on 9/23/2024. Smoke detectors and carbon monoxide detectors were tested and observed functional. There were sufficient supply of both perishable and non perishable foods. The facility has ample supply of warm blankets, sheets and towels available for use of the clients. First aid kit was inspected and observed complete and updated. Medications were observed locked in a cabinet. Hot water in the kitchen measured at 105.6 degrees Fahrenheit. Last fire drill was conducted on 2/8/2025 and last earthquake drill was completed on 2/9/2025.

At around 12:20pm, LPA reviewed P&I money and log. The facility has sufficient surety bond to cover amount of cash being handled at one time. At around 12:30 pm, LPA reviewed medications and Medication Administration Record (MAR). At around 1pm, LPA reviewed 4 client files and 4 staff files. All staff are fingerprint cleared and associated to the facility. They have current First aid and CPR training.

continuation on Lic 809C
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: SANTA CRUZ RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 019200006
VISIT DATE: 02/27/2025
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The following records need to be submitted to CCL by Monday, March 3, 2025:
  • Lic 500
  • Roster of clients
  • Infection Control Plan
  • Emergency Disaster Plan
  • Vehicle registration, insurance and copy of driver's license
  • Liability insurance

Technical violation is issued for today's visit.

A copy of this report was provided to Saygan.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
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