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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802300
Report Date: 07/06/2023
Date Signed: 07/06/2023 11:19:12 AM


Document Has Been Signed on 07/06/2023 11:19 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:HOPE ASSISTED LIVINGFACILITY NUMBER:
405802300
ADMINISTRATOR:CASTANIAGA, JANELYNFACILITY TYPE:
740
ADDRESS:1023 SLEEPY HOLLOWTELEPHONE:
(805) 717-4578
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 6DATE:
07/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Lizeth Tunac - Primary Care GiverTIME COMPLETED:
11:24 AM
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 At 10:40am on 07/06/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct a Case Management visit. LPA met with Primary Care Giver, Lizeth Tunac announced who he was and the reason for the visit. On 07/03/2023 and 07/05/2023, LPA called the facilities main number in response to a transfer request that was denied for a new employee, left two voice messages for call back on both numbers CCLD had for the facility. However, no call back was conducted and prompted this visit. LPA arrived today to ensure that denied employee was not working and that the telephone service for the residents is in compliance with regulations (87311). LPA requested LIC 500 and checked the three current employees working at the facility on this visit, they are all cleared and the denied transfer request employee was not present at the facility and S1 stated that the denied transfer request employee has not started working as of this visit. LPA check facility's phone and facilities phone is working for residents use according to regulation 87311. The facility phone number is (805) 296-7930. LPA advised S1 to have Licensee/Administrator to email LPA to change the phone number to the facility officially. LPA is issuing a technical assistance for the phone number change.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
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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