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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270707506
Report Date: 05/14/2022
Date Signed: 05/14/2022 01:16:34 PM

Document Has Been Signed on 05/14/2022 01:16 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,
, CA
FACILITY NAME:TOLEDO RESIDENTIAL HOME CARE IIFACILITY NUMBER:
270707506
ADMINISTRATOR:TOLEDO, KATHERINEFACILITY TYPE:
735
ADDRESS:25 PENZANCE STREETTELEPHONE:
(408) 670-0786
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 6CENSUS: 5DATE:
05/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator Katherine ToledoTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct an annual/required inspection. LPA Lund met with a caregiver who called Administrator Katherine Toledo a short time later and explained the reason for the visit.

LPA Lund and Administrator Katherine Toledo toured the facility inside and out to include, bedrooms and bathrooms, kitchen, dining room, living room, and exterior. All fire exit routes were free and clear of obstructions. Medications are stored in a locked cabinet in the office. Toxins, cleaning supplies, knives and sharp objects are secured.

Facility observed to have designated entry point for universal symptom screening. All restrooms observed to be supplied with hygiene products. Hand washing signs were posted in bathrooms. Hand sanitizer available to residents. Facility observed to have adequate supply of Personal Protective Equipment (PPE). Staff observed wearing masks.

No citations were issued per the California Code of Regulations, Title 22.

LPA reviewed report with Administrator Katherine Toledo and a copy provided.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2022
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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