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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445200907
Report Date: 03/01/2022
Date Signed: 03/11/2022 04:08:49 PM

Document Has Been Signed on 03/11/2022 04:08 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
CCLD Regional Office,
, CA
FACILITY NAME:APTOS HILLS RANCHFACILITY NUMBER:
445200907
ADMINISTRATOR:SANCHEZ, DEBI & BILLFACILITY TYPE:
735
ADDRESS:133 BROWNS VALLEY ROADTELEPHONE:
(831) 768-1698
CITY:CORRALITOSSTATE: CAZIP CODE:
95076
CAPACITY: 6CENSUS: 6DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Bill Sanchez, Debbie Sanchez, Nerida TiscarenoTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Marybeth Donovan conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Bill Sanchez Administrator, Debbie Sanchez Co- Administrator and Nerida Tiscareno House Manager.

LPA toured the facility inside and out. All fire exit routes were free and clear of obstructions. Sharp objects, toxins, cleaning supplies are secured. Medications are stored in a locked cabinet in the kitchen.

Facility observed to have designated entry point for COVID 19 symptom screening. Bathroom observed to be supplied with hygiene products and hand Washing sign posted. Hand sanitizer available to visitors and residents. LPA observed supply of Personal Protective Equipment (PPE). COVID 19 signs posted included Visitor Policy, Face Coverings Required For Entry, Cover Your Face, Limit Family Gatherings, We All Play a Roles, and COVID 19 Response.

LPA reviewed the facility policies and procedures to include screening, visitation, masking, isolation and disinfecting,

No citations were issued per the California Code of Regulations, Title 22.

LPA reviewed report with Bill Sanchez Administrator, Debbie Sanchez Co-Administrator Nerida Tiscareno House Manager and a copy provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Marybeth Donovan
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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