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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275200010
Report Date: 08/27/2021
Date Signed: 08/27/2021 06:50:22 PM

Document Has Been Signed on 08/27/2021 06:50 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MELINDA'S GUEST HOMEFACILITY NUMBER:
275200010
ADMINISTRATOR:MELINDA M. TAMONTEFACILITY TYPE:
735
ADDRESS:946 SLOAT DRIVETELEPHONE:
8315780627
CITY:SALINASSTATE: CAZIP CODE:
93907
CAPACITY: 6CENSUS: 6DATE:
08/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Melinda TamonteTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an unannounced infection control site visit today. LPA met with the Licensee Melinda Tamonte.

One central entry point was designated for all staff, residents, and visitors. A temperature screening station, sign in sheet, and hand sanitizer were present at the entrance.

LPA toured the facility. The facility was observed to be in sanitary condition. All staff members were observed to be wearing masks. There were COVID-19 tips and prevention signs at the entrance.

LPA inspected a restroom. The restroom was observed to be adequately stocked with paper towels and hand soap. A Trash bin with lid was present. Hand washing sign was posted.

Facility was observed to have an adequate supply of PPE in the storage area. LPA discussed the infection control with the Licensee and the 2 staff. LPA made recommendations and discussed the PIN 21-10-ASC. 6 out of 6 residents, and all staff were fully vaccinated per Licensee.

Advisory notes (LIC 9102) were issued. No deficiency cited during visit.

This report was reviewed with the Licensee.

A copy of this report and advisory notes were provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Yatfai Ng
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2021
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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