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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202316
Report Date: 05/14/2022
Date Signed: 05/14/2022 03:30:27 PM

Document Has Been Signed on 05/14/2022 03:30 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,
, CA
FACILITY NAME:GARDENIA'S GUEST HOMEFACILITY NUMBER:
275202316
ADMINISTRATOR:DILCIA RAMIREZFACILITY TYPE:
735
ADDRESS:832 CACTUS CT.TELEPHONE:
(831) 578-5002
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 6CENSUS: 6DATE:
05/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Caregiver KevinTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above address to conduct an unannounced annual/required annual visit and met with Caregiver Kevin Plunkett who called Administrator Dilcia Ramirez who could not make to the facility. Administrator Dilicai Ramirez gave Caregiver Kevin Plunkett permission to sign required paperwork.

LPA Lund and Caregiver Kevin Plunkett toured the facility inside and out to include, 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 kitchenette area. Toxins, cleaning supplies, knives and sharp objects are secured.

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).

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

LPA Lund called Administrator Dilicai Ramirez and reviewed the annual/required inspection along with Caregiver Kevin Plunkett. Report left with Caregiver Kevin Plunkett.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2022
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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