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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445201068
Report Date: 04/18/2023
Date Signed: 04/18/2023 03:20:32 PM

Document Has Been Signed on 04/18/2023 03:20 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:CROSSROADSFACILITY NUMBER:
445201068
ADMINISTRATOR:SANCHEZ, DANIELFACILITY TYPE:
735
ADDRESS:819 FREEDOM BLVD.TELEPHONE:
(831) 768-1641
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 6CENSUS: 5DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Daniel SanchezTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) David Marrufo and Trang Pham conducted an unannounced Required 1 Year visit and met with Daniel Sanchez, Administrator/Licensee.

During visit, LPAs toured the facility. The kitchen area had a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days. LPAs observed 1 out of 1 bathrooms had available soap and paper towels. The bathroom water temperature was 117 F. LPAs observed 3 out of 3 resident bedrooms and observed beds with bedding, functioning lights, and available clothing storage areas. The smoke detectors in each room and in the hallway were shown to be functional when tested. The carbon monoxide detector functioned properly when tested.

LPAs reviewed the facility medications and the Personal and Incidental Logs, which were found to be complete. LPAs reviewed resident and staff records. Resident R1 and R2 had Appraisal/Needs and Services Plans that needed signatures. R1 also did not have a Safeguard for Property and Valuables.

Advisory Notes were issued. See LIC9102 Advisory Notes for more information.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Administrator/Licensee Daniel Sanchez and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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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