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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202260
Report Date: 06/29/2021
Date Signed: 06/29/2021 11:43:28 AM

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:ARCHWAY OF CARMELFACILITY NUMBER:
275202260
ADMINISTRATOR:CYRIL TUPINOFACILITY TYPE:
740
ADDRESS:3262 TAYLOR ROADTELEPHONE:
(831) 269-4164
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:6CENSUS: 4DATE:
06/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Cyril TupinoTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Marybeth Donovan conducted an unannounced Infection Control site visit and met with Cyril Tupino Administrator.

LPA toured the facility inside and out to include the entry, 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 garage. Toxins, cleaning supplies, knives and sharp objects are secured. Interior temperature 72 degrees Fahrenheit and hallway bathroom water temperature 107.6 degrees Fahrenheit.

In the kitchen LPA observed a minimum of 2 day perishable food supply and 7 day non perishable food supply. LPA observed fresh fruit of apples, oranges and cherries.

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.

LPA reviewed the facility policies and procedures to include screening, isolation, disinfecting, staffing, training, supplies, PPE usage and social distancing.

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

LPA reviewed report with Cyril Tupino Administrator and a copy provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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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