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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202178
Report Date: 09/13/2024
Date Signed: 09/25/2024 11:59:42 AM

Document Has Been Signed on 09/25/2024 11:59 AM - 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:OPAL CLIFF RESIDENTIAL CENTERFACILITY NUMBER:
445202178
ADMINISTRATOR/
DIRECTOR:		MULIFANUA ASUEGAFACILITY TYPE:
735
ADDRESS:4795 OPAL CLIFF DR.TELEPHONE:
(831) 420-0120
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 15CENSUS: 15DATE:
09/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Monica HernandezTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Monica Hernandez.

During visit, LPA toured the facility inside and out. LPA toured the facility kitchen area and the food storage area. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days.

LPA toured 8 out of 8 resident bedrooms and observed each bedroom to have working lights and available bedding and clothing storage areas. The facility smoke detector system was tested during visit and found to function properly. LPA tested two out of two carbon monoxide detectors and found them to function properly. LPA toured 3 out of 3 resident bathrooms and observed each bathroom to have available soap and paper towels as well as working lights. LPA measured the water temperatures in the bathroom sinks and they measured at 105 F, 115 F, and 119 F.

LPA toured the outside area and found the exits to be clear of obstructions.

LPA reviewed 5 resident records and Centrally Stored Medication and Destruction records and found them to be complete. LPA reviewed 3 out of 3 Personal and Incidental Money Logs and found them to be balanced. LPA reviewed 5 staff records and found them to be complete.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Monica Hernandez and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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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