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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445201068
Report Date: 04/11/2024
Date Signed: 04/11/2024 01:57:11 PM

Document Has Been Signed on 04/11/2024 01:57 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/
DIRECTOR:		SANCHEZ, DANIELFACILITY TYPE:
735
ADDRESS:819 FREEDOM BLVD.TELEPHONE:
(831) 768-1641
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 6CENSUS: 5DATE:
04/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Daniel SanchezTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Daniel Sanchez.

During visit, LPA Marrufo reviewed the Personal and Incidental Money Log, Centrally Stored Medications Log, Resident Records, and Staff Records and found them to be complete.

LPA Marrufo toured the resident bathroom and observed the water temperature to be 107 F. The bathroom had available soap and paper towels and working lights.

LPA Marrufo toured 3 out of 3 resident bedrooms. Each bedroom had functioning lights, available bedding, and functioning smoke detectors.

LPA Marrufo toured the kitchen area and observed there to be a perishable food supply of two days and a non-perishable food supply of seven days.

LPA Marrufo toured the outside area and found the outdoor exit to be clear of obstructions.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Daniel Sanchez and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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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