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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803572
Report Date: 04/18/2024
Date Signed: 04/18/2024 03:50:47 PM

Document Has Been Signed on 04/18/2024 03:50 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:E.R. SALGADO,INC./SALGADO BOARD & CARE HOMEFACILITY NUMBER:
486803572
ADMINISTRATOR/
DIRECTOR:
ROSE SALGADOFACILITY TYPE:
735
ADDRESS:570 INVERNESS DRIVETELEPHONE:
(707) 315-4838
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 10CENSUS: 10DATE:
04/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Rose SalgadoTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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LPA Hiratsuka conducted this unannounced annual visit.

This facility has a fire clearance for ten residents. There are four shared resident rooms and two private resident rooms. There are three staff rooms. There is one full bathroom outside by the staff rooms. There is one full common bathroom and one room has a full private bathroom. The food supply meets regulations. LPA toured the resident rooms, staff area, and common areas. LPA toured the backyard.

Today the following was discussed:
-The corporation was suspended. Administrator called her accountant and was able to get it reactivated.
-Administrator stated she is currently updating the staff files.
-Updates to resident files.

LPA reviewed four resident files and three staff files.

Several other topics were discussed

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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