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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445200890
Report Date: 12/09/2024
Date Signed: 12/09/2024 02:21:27 PM

Document Has Been Signed on 12/09/2024 02:21 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:PUENTES HOMEFACILITY NUMBER:
445200890
ADMINISTRATOR/
DIRECTOR:		GEURIN, SCOTT R.FACILITY TYPE:
735
ADDRESS:316 HUSHBECK AVENUETELEPHONE:
(831) 724-8896
CITY:WATSONVILLSTATE: CAZIP CODE:
95076
CAPACITY: 6CENSUS: 2DATE:
12/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Licensees, Scott and Juana GeurinTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analysts (LPAs) Marcella Tarin and Kenneth Madrigal conducted an unannounced annual inspection and met with Licensees Scott and Juana Geurin. Licensees informed LPAs that the facility has 2 staff and 2 clients.

LPAs toured the interior and exterior of the facility out with the licensees to include the kitchen, office area, bedrooms, restrooms, living room, dining room, garage and patio area. The front yard and backyard of the facility was also inspected. All exits were free and clear of obstruction.

LPAs toured the kitchen area, and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. Kitchen water temperature was measured at 114.2 degrees F. The refrigerator and freezer temperatures were observed at 36 degrees F and 0 degrees F (displayed on digital display on interior refrigerator door). LPAs observed the toxins and knives storage area was locked and inaccessible to clients in care (inside a bottom kitchen cabinet).

LPAs toured 2 client bedrooms, 1 staff room and 1 private bedroom (Licensees). 2 out of 2 client bedrooms had a bed, cleaning bedding, functioning lights, a chair, dresser and storage space for personal belongings. Water temperature measured in 1 hallway client restroom measured at 108.3 degrees F.

The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested. Fire extinguishers were last serviced on 8/20/2024. LPAs observed the facility first aid kit and it was observed to be complete. The facility fire/earthquake drill log was reviewed. The facility's last drill was on 12/8/2024..

See LIC809-C

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: PUENTES HOME
FACILITY NUMBER: 445200890
VISIT DATE: 12/09/2024
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No Centrally Stored Medication and Destruction Records (CSMDRs) were review. Licensees states 2 out of 2 clients do not require medication.

LPAs reviewed staff and clients records. 2 out of 2 staff records were observed to be complete and included medical assessment, TB results, personnel record, and background clearance. 2 out 2 client records were observed to be complete and included physician's reports, need/services plans, and emergency information. LPAs observed 2 clients P&I records to be documented accurately.

No deficiencies were cited during today's inspection. This report was reviewed with Licensees Scott and Juana Geurin and a copy of the report was provided.

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC809 (FAS) - (06/04)
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