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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601078
Report Date: 08/21/2024
Date Signed: 08/21/2024 01:46:54 PM

Document Has Been Signed on 08/21/2024 01:46 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CRISTINA'S CARE HOMEFACILITY NUMBER:
415601078
ADMINISTRATOR/
DIRECTOR:		MADRIGAL, OSCARFACILITY TYPE:
740
ADDRESS:2735 FLEETWOOD DRIVETELEPHONE:
(650) 952-5370
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 6CENSUS: 6DATE:
08/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Caregiver, Wilfredo MonoyTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On August 21, 2024, Licensing Program Analyst (LPA), Murial Han conducted an unannounced Case Management visit to deliver the findings of an incident that was reported by the facility. LPA met with caregiver, Wilfredo Monoy and explained the purpose to today's visit.

On February 14, 2024, facility reported resident #1 (R1) was hospitalized due to a change of health condition and on the day of the discharge, R1 verbalized to the hospital staff that he/she was sexually abused by staff #1 (S1).

As part of the investigation, the Department interviewed staff members, residents and R1's responsible party. The facility staff stated that they have not witnessed any suspicious or inappropriate behavior involving S1 toward R1 or other residents; other residents reported that they feel safe at the facility and R1's responsible party reported that R1 was not a reliable historian.

After the investigation, this incident is deemed to be unsubstantiated.

No deficiency is being cited today.

This report is reviewed and discussed with caregiver and a copy if provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2024
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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