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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201316
Report Date: 10/05/2021
Date Signed: 10/05/2021 11:27:12 AM

Document Has Been Signed on 10/05/2021 11:27 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:SALINAS SENIOR DAY PROGRAMFACILITY NUMBER:
275201316
ADMINISTRATOR:CHRISTINA HUNTFACILITY TYPE:
775
ADDRESS:408 SALINAS STREETTELEPHONE:
(831) 422-3999
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 21CENSUS: 3DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Sia KatoaTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Sia Katoa.

During visit, LPA toured the facility. LPA observed the main activity room, hallways, two out of two bathrooms, storage supply room, and office. LPA Marrufo observed COVID-19 related posters throughout the hallways and bathrooms. LPA observed the bathrooms had available soap and paper towels. The storage room had a PPE supply of at least 30-days and sanitation supplies. The entry had a visitor screening area.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Sia Katoa and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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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