<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202192
Report Date: 07/19/2023
Date Signed: 08/18/2023 10:38:00 AM


Document Has Been Signed on 08/18/2023 10:38 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:CRISTINE'S GUEST HOME IIFACILITY NUMBER:
275202192
ADMINISTRATOR:MA CRISTINA DEL ROSARIOFACILITY TYPE:
740
ADDRESS:852 ANTIGUA AVENUETELEPHONE:
(831) 998-8162
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:6CENSUS: 6DATE:
07/19/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator, Joe Del Rosario TIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit to conduct a Case Management (Plan of Correction) visit. LPA Hurt met with facility Administrator Joe Del Rosario and explained the purpose of todays visit.

LPA Hurt cited 87303 (d)(2) Personal Accommodations and Services with a Plan of Correction Licensee will remove Residents from facility Bedroom #1 and Bedroom #2 until black substance inside the window sill is tested, and removed. LPA Hurt observed the residents from Room #2 have been relocated to a different facility owned by the Licensee. LPA Hurt observed the furniture in Bedroom #2 on top of the beds and the carpet wet as if recently cleaned.

LPA Hurt observed what appeared to be possible mold in the window sill of bedroom # 3. Licensee stated she was not aware of the mold in room #3 because she trusted her staff to inform her of these types of incidents and they clearly were not. Licensee stated she is willing to relocate the residents from Room #1, and Room#3 to a hotel along with a staff member, the residents medications, and food for the residents. Licensee stated the residents living in Room #1 and Room#3 declined the leave the facility to the hotel until the mold in the window sill is tested and cleaned.

LPA Hurt overheard Resident 1 on the phone with Licensee stating they did not want to relocate to a hotel.

LPA Hurt will clear the deficiencies cited on 07/17/2023 once the Licensee provides proof the possible mold has been tested, and if proven to be a hazardous substance completely removed from the facility.

No deficiencies are being cited today Per Title 22 Regulations. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1