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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803572
Report Date: 05/27/2022
Date Signed: 05/27/2022 05:02:07 PM

Document Has Been Signed on 05/27/2022 05:02 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:E.R. SALGADO,INC./SALGADO BOARD & CARE HOMEFACILITY NUMBER:
486803572
ADMINISTRATOR:ROSE SALGADOFACILITY TYPE:
735
ADDRESS:570 INVERNESS DRIVETELEPHONE:
(707) 315-4838
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 10CENSUS: 10DATE:
05/27/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Rose Salgado, LicenseeTIME COMPLETED:
05:00 PM
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On 5/27/2022 LPA Tobola, Licensing Program Manager Mota and Regional Manager, Nuti-Martinez met with Licensee, Rose Salgado for the purpose of an informal office meeting to discuss concerns and deficiencies regarding the facility. The meeting is being conducted virtually due to COVID-19.

LPA discussed multiple deficiencies cited during the facility's annual inspection with the Licensee. The Licensee stated that an in-service training/meeting with staff was conducted ensuring all staff are to notify the Licensee of any changes to the schedule or if additional staff is needed. All staff understand the responsibility of care for clients and are to be present at all times for client care. Licensee has also hired an additional caregiver staff for to cover for any staffing shortages or gaps between shift changes. Licensee's daughter has also received Administrator certification and provides care during the weekends as well as evenings on weekdays.

Licensee has created an updated schedule that indicates tasks to be completed by the staff every 1-2 hours which will be provided to LPA for review.

Facility has conducted a deep clean of the restroom and replaced shower curtains. Photos were shown and will be provided to LPA to clear deficiency. Licensee also stated that the facility has updated their policy to clean restroom 2-3 times per day and direct clients to use restroom in a more sanitary way.

No deficiencies cited.

Report was reviewed and electronic copy was provided to Licensee for signature. All signatures on file.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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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