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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600072
Report Date: 07/06/2020
Date Signed: 07/06/2020 03:09:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CRISTINA'S CARE HOMEFACILITY NUMBER:
415600072
ADMINISTRATOR:ARNOLD MORALESFACILITY TYPE:
740
ADDRESS:1580 CRESTWOOD DRIVETELEPHONE:
(650) 483-1202
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:6CENSUS: 6DATE:
07/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Juliet Pacaldo, AdministratorTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Raygoza conducted a facility closure case management inspection via virtual facetime to verify the facility closure. LPA met with Administrator, Juliet Pacaldo and stated purpose of visit. Juliet stated Cristina Flores is no longer operating the facility. An email and copy of closure letter was submitted to CCL Office. License to be surrendered and submitted to CCL Office. The facility is operating under a new licensee and with new Administrator under license #415601077 as of 6/17/2020.

This facility has since ceased operating under license number 415600072. Forfeiture letter will be issued by CCL Office.

This report was reviewed and discussed with Administrator, Juliet Pacaldo upon exit.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Bertha RaygozaTELEPHONE: (650) 266-8833
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2020
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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