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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803573
Report Date: 04/29/2022
Date Signed: 04/29/2022 03:08:17 PM

Document Has Been Signed on 04/29/2022 03:08 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:E.R.SALGADO,INC./SAINT LUCIA RESIDENTIAL CAREFACILITY NUMBER:
286803573
ADMINISTRATOR:ROSE SALGADOFACILITY TYPE:
735
ADDRESS:134 LANDANA STREETTELEPHONE:
(707) 315-4838
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY: 6CENSUS: 6DATE:
04/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Administrator, Rose SalgadoTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived at E.R. Salgado, Inc./Saint Lucia Residential Care unannounced for the purpose of conducting a Case Management-Other inspection. LPA was granted access into the facility by an Independent Living Client. Staff Member, Gloria Navarro was present at the facility. The purpose of the Case Management-Other inspection is to verify staff ratios and to ensure staff are on premises providing Care and Supervision to clients in care.

LPA observed staff one staff member at the facility providing Care and Supervision. A search of Licensing Information System (LIS) reflects that both individuals were background cleared and associated to the facility. During the Case Management-Other inspection, LPA toured the facility and grounds. LPA observed 3 bedrooms that house 2 clients per bedroom. Currently, the facility is at 6 clients and "2" independent clients residing at the back of the facility closest to the backyard. Both Independent Clients share the same bedroom. The Department is requesting the Licensee for an office visit to discuss client concerns regarding capacity and care.

No deficiencies were cited during today's Case Management-Other inspection. Exit interview was conducted and a copy of this report was given to the Facility Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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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