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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440708739
Report Date: 08/03/2022
Date Signed: 08/03/2022 02:43:33 PM


Document Has Been Signed on 08/03/2022 02:43 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
CENTRAL COAST CR/RES, 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: 3DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Cecilia SullivanTIME COMPLETED:
02:44 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 08/03/2022 at 01:28pm. 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. Facility water temperature observed to be 109.9*F. Facility temperature observed to be 72*F.

30 day supply of PPE observed was not observed, as the facility did not have any gowns. All restrooms stocked with paper towers. Hand washing signs observed in all bathrooms. Bathrooms did not have foot operated lidded trash cans. Social distancing signs observed to be posted in all public areas. Facility observed to have designated entry point. Staff took LPA's temperature, and screened for symptoms.

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: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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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