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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801863
Report Date: 06/24/2022
Date Signed: 06/28/2022 11:41:21 AM

Document Has Been Signed on 06/28/2022 11:41 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CRISMA CARE FACILITYFACILITY NUMBER:
486801863
ADMINISTRATOR:NOBLEJAS, CRISTINAFACILITY TYPE:
735
ADDRESS:100 ARAGON STREETTELEPHONE:
(707) 644-8828
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 6CENSUS: 0DATE:
06/24/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Christina NoblejasTIME COMPLETED:
02:40 PM
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An informal meeting was conducted today, by the Santa Rosa Regional Office with Crisma Care Facility, via Microsoft Teams, due to Covid19 precautions. Present in the meeting were Licensing Program Manager, Kimberley Mota, Licensing Program Analyst, Araceli Canela and Licensee/Administrator, Christina Noblejas.

This Informal Conference meeting is being conducted to discuss concerns identified by the Licensing Agency in regards to the operation of this facility.

Items addressed during the meeting include, but are not limited to, the areas below:
  • Reporting requirements – incident reports not being reported to Community Care Licensing (CCL)
  • Accessible medication
  • Facility staff not following Covid precautions.
  • Administrator Qualifications and Duties (Reg. 85064) The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.

Documents requested during informal meeting to be submitted to CCL by June 30, 2022:
Licensee will submit an updated LIC500.


No deficiencies cited during today’s informal conference.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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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