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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202838
Report Date: 11/10/2021
Date Signed: 11/10/2021 04:20:47 PM

Document Has Been Signed on 11/10/2021 04:20 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:HARTNELL HOME TWOFACILITY NUMBER:
275202838
ADMINISTRATOR:BINARAO, PATRICKFACILITY TYPE:
735
ADDRESS:620 COLLEGE DR.TELEPHONE:
(831) 753-7630
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 6CENSUS: 4DATE:
11/10/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alvin TeodoroTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Steve Chang conducted a pre-licensing inspection today for a change of ownership. LPA met with Licensee Alvin Teodoro (AT) and administrator (ADM) Patrick Binarao.

LPA toured the facility inside out with ADM. COVID posters and Screening station with hand sanitizer, face mask, thermometer, and infection control questionnaires were observed. The facility equipped with smoke and carbon monoxide detectors. ADM operated and tested the smoke doctors, and all operated fine. Fire extinguisher was observed in the facility, and was serviced on 09/23/2021.

Knives closet, medication closet, and cleaning product closet were observed locked. Living room, dinning room, and kitchen were observed in good repair. Paper towel with holder in kitchen was observed. One staff live-in room, 2 single resident rooms, one resident shared room and two restrooms were inspected. The beds in shared room were observed 6 feet apart. Not all the trash cans were with covers. ADM stated the facility will fix this issue in two weeks. One resident Patrick Bradley was observed in facility, the other 3 residents went out for day program. One staff Reyfrancis Vergagra was observed in the facility. Room temperature was 69 degree F, and hot water temperature was at 105 degree F. Laundry area and garage were inspected. PPE supplies were observed sufficient. Two day perishable food supplies and seven days nonperishable food supplies were observed sufficient.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: HARTNELL HOME TWO
FACILITY NUMBER: 275202838
VISIT DATE: 11/10/2021
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LPA reviewed and discussed with AT. AT stated all staff and residents are fully vaccinated with Pfizer. Backyard and front yard were inspected, and no obstruction was observed.

Component III orientation was completed with licensee. No issues noted during the pre-licensing inspection. The physical plant is approved pending the completion of Centralized Application Bureau (CAB) review of the facility application. Exit interview conducted with and copy of report provided to licensee AT.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
LIC809 (FAS) - (06/04)
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