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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440708739
Report Date: 08/30/2021
Date Signed: 08/30/2021 05:07:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SEAVIEW GUEST HOMEFACILITY NUMBER:
440708739
ADMINISTRATOR:SULLIVAN, CECILIAFACILITY TYPE:
740
ADDRESS:7321 MESA DRIVETELEPHONE:
(831) 685-2428
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:6CENSUS: 4DATE:
08/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Cecilia SullivanTIME COMPLETED:
11:34 AM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 08/30/2021 at 09:58am. LPA met with facility Administrator Cecilia Sullivan (Admin).

LPA toured the facility, including living room, kitchen, dining room, garage, 5 bedrooms, 2 bathrooms, back patio, and side patios. All staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated.

Facility Mitigation plan has already been submitted. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. 30 day supply of PPE observed. All restrooms stocked with paper towers. Hand washing signs observed in all bathrooms. Social distancing signs observed to be posted in all public areas.

Facility observed to have designated entry point. Staff did not take LPA's temperature, nor did they screen for symptoms. Facility does not have a visitor screening log. LPA advised Admin to start maintaining visitor, staff, and resident logs to monitor and document temperature and symptoms of persons entering the facility. Admin created screening log while LPA was at the facility.

No deficiencies cited during today's visit. Advisory notes issued. This report was reviewed with Administrator Cecilia Sullivan and a copy of the signed report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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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