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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202752
Report Date: 03/24/2025
Date Signed: 03/25/2025 10:52:16 AM

Document Has Been Signed on 03/25/2025 10:52 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:MESSINGER CARE HOMEFACILITY NUMBER:
275202752
ADMINISTRATOR/
DIRECTOR:		ESTAMO, JUANITO JRFACILITY TYPE:
740
ADDRESS:3121 MESSINGER DRTELEPHONE:
(831) 883-9386
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
03/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:45 PM
MET WITH:Licensee, Juanito EstamoTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Maria Estamo, Continual Administrator's Certification expires 02/17/2026. There are currently 3 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 112 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA reviewed Infection control plan.

Resident 1 does not have complete medical assessment. The facilities PUB 475 is not required size (20x26). Facilities LIC610E Emergency Disaster Plan is not complete or on updated current form. LPA observed Resident 2's bedroom does not have required furnishings (lamp). Staff 1 and staff 2 do not have files at the facility for review. LPA observed Resident 3 has full bed rails.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Maria Estamo, and copy of report left at facility
Brenda ChanTELEPHONE: (650) 266-8800
Sarah HurtTELEPHONE: 559-243-8080
DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2025
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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Document Has Been Signed on 03/25/2025 10:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA


FACILITY NAME: MESSINGER CARE HOME
FACILITY NUMBER: 275202752

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
CCR
87458(c)
Medical Assessment
(c) The medical assessment shall include, but not be limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in Resident 1 does not have a completel medical assesment avaialble for review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/08/2025
Plan of Correction
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Licensee will submit full Physicians report for resident 1 to LPA by POC date of 04/08/2025.
Type B
Section Cited
HSC
1569.695(a)
Other Provisions
(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the facilities Emergency Disaster plan is not complete or on current updated form, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/08/2025
Plan of Correction
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Licensee will submit correct current updated LIC610E to LPA by POC date of 04/08/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephenie DoubTELEPHONE: (916) 263-2131
Sarah HurtTELEPHONE: (916) 879-2602

DATE: 03/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2025

LIC809 (FAS) - (06/04)
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