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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201303
Report Date: 10/02/2024
Date Signed: 10/02/2024 03:16:23 PM

Document Has Been Signed on 10/02/2024 03:16 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:NURTURE PLUS CARE HOMEFACILITY NUMBER:
079201303
ADMINISTRATOR/
DIRECTOR:		JOFFRE GRANT CUENCOFACILITY TYPE:
735
ADDRESS:968 SEASCAPE CIRCLETELEPHONE:
(415) 420-5672
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY: 4CENSUS: 0DATE:
10/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Cherrielyn Cuenco, Co-Administrator TIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On 10/02/2024 at 1:50PM, Licensing Program Analyst (LPA) C. Fowler arrived to conducted an unannounced 1-Year Required inspection. LPA met with Co-Administrator, Cherrielyn Cuenco and explained the purpose of the visit. Administrator, The Administrator Joffre Grant Cuenco currently holds a certificate (#6069542735) that expires on 07/13/2025, The facility’s fire clearance was approved for two (2) non-ambulatory and two (2) ambulatory clients.

LPA toured the facility with Co-Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of four (4) total bedrooms which four (4) bedrooms are occupied by clients. There are two (2) full bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the shared clients’ bathroom was measured at 105.0 degrees Fahrenheit. There are no clients in the facility.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/20/2023 Administrator will purchase new updated Fire extinguisher. Facility will post Emergency Disaster Plan. First aid kit was observed to be complete. No clients at the facility so there's no Fire drills conducted.

Continued on LIC809C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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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: NURTURE PLUS CARE HOME
FACILITY NUMBER: 079201303
VISIT DATE: 10/02/2024
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Continue from LIC 809

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/11/2024:

LIC 500 Personnel Report
LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 400 Affidavit Regarding Client/Resident Cash Resources
LIC 402 Surety Bond
LIC 610E Emergency Disaster Plan


Exit interview conducted, a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
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