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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275200248
Report Date: 08/26/2021
Date Signed: 08/27/2021 08:40:34 AM

Document Has Been Signed on 08/27/2021 08:40 AM - 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:C & D CARE FACILITY # 2FACILITY NUMBER:
275200248
ADMINISTRATOR:DAISY PARCASIOFACILITY TYPE:
735
ADDRESS:1144 ROCKHAVEN COURTTELEPHONE:
(831) 443-1637
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 6CENSUS: 6DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Daisy ParcasioTIME COMPLETED:
12:30 PM
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Licensing Program Analyst, Steve Nguyen, conducted an unannounced annual inspection with Administrator Daisy Parcasio.

LPA toured facility inside and out. LPA observed: Covid signs are present and in conspicuous vantage points, emergency contact for residents were up to date, facility screening protocols were in effect, hand sanitizing station were available throughout facility, medicine cabinet were observed to be locked, paper towers are in use, beds are at least 6 feet apart and physical distancing was observed to be in practice.

During inspection, LPA identified and AD concurred: 11 chairs, 3 lounge chairs in the back yard that needs to be disposed by 8/27/2021. Additionally, 4 widow screens around the house needs to be replace by 9/2/2021. AD will submit photos and receipts to Department when tasks are completed.

No citation was issued at this time.

LPA went over report findings with Administrator, Daisy Parcasio, for review and a copy was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Steve Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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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