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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202747
Report Date: 11/23/2022
Date Signed: 11/23/2022 12:35:49 PM


Document Has Been Signed on 11/23/2022 12:35 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:DEL MONTE ASSISTED LIVING FACILITY, THEFACILITY NUMBER:
275202747
ADMINISTRATOR:SANDEEP SAINIFACILITY TYPE:
740
ADDRESS:1229 DAVID AVETELEPHONE:
(831) 375-2206
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:49CENSUS: 31DATE:
11/23/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Ashley RiderTIME COMPLETED:
12:37 PM
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Licensing Program Analyst Ryker Heberle (LPA) arrived at the facility unannounced to conduct a health check for residents at the facility. LPA met with facility Administrator in Training Ashley Rider (Admin).

LPA toured houses 1, 4, 5, and 6. During tour of the units, LPA observed the facilities to be clean and in good repair with no evident hazards. LPA toured the rooms of 5 residents. No prohibited items were noted in any resident rooms. Emergency exits were unobstructed. All bedrooms were at a comfortable temperature and supplied with adequate furnishing. Rooms were not observed to have any notable damage, and free from tripping hazards.

LPA attempted to interview 5 facility residents. 4 out of 5 residents agreed to be interviewed, with one resident indicating that "now wasn't a good time to talk." 4 out of 4 residents stated during conversation that everything was going well at the facility. 4 out of 4 residents indicated that staff are kind, attentive, and expedient in providing care. 4 out of 4 residents stated that they feel safe at the facility. When asked about whether they received recent injuries, 4 out of 4 residents indicated that they hadn't.

No deficiencies cited during today's inspection. This reported was reviewed with Administrator in Training Ashley Rider (Admin) and a signed copy was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2022
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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