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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201180
Report Date: 02/20/2025
Date Signed: 02/20/2025 12:34:32 PM

Document Has Been Signed on 02/20/2025 12:34 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:KRISTA & KRIS CORPORATIONFACILITY NUMBER:
019201180
ADMINISTRATOR/
DIRECTOR:		ALFONSO, AMELIAFACILITY TYPE:
735
ADDRESS:5541 ROOSEVELT PLACETELEPHONE:
(650) 255-9603
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 6CENSUS: 5DATE:
02/20/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Amelia Alfonso, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 02/20/2025 at 10:50 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Holmes conducted a Case Management Visit. LPAs met with staff member, John Coloma, and explained the purpose of the visit. Administrator, Amelia Alfonso, arrived shortly after.

While LPAS were at the facility to investigate for a complaint (15-AS-20250218133433), LPAs observed the following:
  • Several flies flying around the inside the house in the living room, kitchen and in client's room.
  • Lysol spray, toilet bowl cleaners, bar soaps, and toothpaste found in the same cabinet as as the canned goods, pasta sauce, and condiments.

The following deficiencies was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted with Staff. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 02/20/2025 12:34 PM - It Cannot Be Edited


Created By: Patricia Manalo On 02/20/2025 at 11:13 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: KRISTA & KRIS CORPORATION
FACILITY NUMBER: 019201180

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
80087(a)(1)

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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times...(1)The licensee shall take measures to keep the facility free of flies and other insects.

This requirement is not met as evidenced by:
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Administrator agrees to put out fly insect traps, contact pest control to remove the flies, and send proof to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above by having flies in the living room, kitchen, and in client's bedroom which poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Patricia Manalo
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/20/2025 12:34 PM - It Cannot Be Edited


Created By: Patricia Manalo On 02/20/2025 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: KRISTA & KRIS CORPORATION
FACILITY NUMBER: 019201180

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2025
Section Cited
CCR
80076(a)(16)

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80076 Food Services
(a) In facilities providing meals to clients... (16) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.

This requirement is not met as evidenced by:
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The facility removed the cleaning supplies from the storage room on this date. Deficiency cleared on this date.
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Based on observation, the licensee did not comply with the section cited above in having canned goods in the same storage space as the cleaning chemicals such as toilet bowl cleaner, lysol spray, bar soaps, and toothpaste which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Patricia Manalo
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
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