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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801517
Report Date: 07/01/2020
Date Signed: 07/01/2020 05:05:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117
FACILITY NAME:PACIFIC HEIGHTS RESIDENTIAL HOMEFACILITY NUMBER:
405801517
ADMINISTRATOR:CHERYLN CRADDUCKFACILITY TYPE:
740
ADDRESS:781 LILAC DRIVETELEPHONE:
(805) 704-6283
CITY:LOS OSOSSTATE: CAZIP CODE:
93402
CAPACITY:5CENSUS: 3DATE:
07/01/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:49 PM
MET WITH:Cherlyn Cradduck, AdministratorTIME COMPLETED:
04:21 PM
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At 3:49 pm, Licensing Program Analyst (LPA) Darlene Chavez conducted a visit to verify that Staff 1 (S1) was not working at the facility. CCL received information that S1 could not be present in the facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted telephonically via FaceTime with Cherlyn Cradduck, the facility administrator.

LPA Chavez asked the administrator if S1 was working in the facility, and the administrator stated that S1 had not worked at the facility for over 3 years. LPA Chavez asked the date he last worked, and the administrator stated June of 2017. LPA Chavez conducted a walk-through of the facility and observed staff. The administrator introduced LPA Chavez to caregivers.

LPA Chavez collected a copy of the facility’s current staff schedule.

Based on evidence obtained during today's visit, the LPA has verified the individual is not present, employed, or residing at the facility. LPA has advised the licensee to request to disassociate the individual from their roster.

An exit interview was conducted and an electronic copy of the report was emailed to the administrator to be signed and returned to the LPA via email.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) -59-343
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: 805-450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020
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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