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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801863
Report Date: 02/14/2024
Date Signed: 02/21/2024 12:29:48 PM

Document Has Been Signed on 02/21/2024 12:29 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, 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: 5DATE:
02/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Estella Constantino, care staffTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) A. Canela arrived at this facility unannounced, to conduct a Case Management and met with house manager, Estella Constantino; Christina Noblejas was out of town and LPA Canela later reached licensee by phone.
This facility previously sent in a request for a decrease of capacity due to a fire clearance that was requested for a review of additional non-ambulatory clients. Per a previous review of a fire clearance room #2 was said to be only approved for 1 non-ambulatory client only, and the decrease of capacity was submitted for approval of 1 non-ambulatory client. LPA spoke with fire inspector who informed LPA that the facility could have 1 ambulatory client and 1 non-ambulatory in that room, just not 2 non-ambulatory since the facility corrected the push door and the facility has working fire sprinklers.
LPA spoke with licensee who stated she wanted to withdraw the decrease of capacity application and redo paperwork for 5 non-ambulatory and 1 ambulatory and with the current capacity of 6 clients.
LPA will inform fire inspector of a new fire clearance coming in with capacity 6.
LPA explained to care staff that the facility needs to ensure they are following the fire inspectors requests and corrections immediately or the facility may be cited and civil penalties may be applied for fire safety. Fire inspector previously notified LPA the facility was requested to remove electrical cords in the garage and when they went back, it was still an issue. Exit door signs were also requested. LPA informed staff that these request should be done and corrected immediately and they should not wait until the last minute. Failure to comply will warrant citations. LPA requested the lamp in room #3 to get the lamp fixed, as the twist button is not working properly and the light does not turn on correctly.

LPA went over client C1 who was recently seen in emergency for an infection in foot, C1 is doing much better, C1 was out at day program. C1 was seen my home health and sees the doctor every 2 weeks for follow ups. LPA will return once a new fire clearance has been approved.

No citations issued during todays inspection.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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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