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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275294362
Report Date: 11/02/2021
Date Signed: 11/02/2021 01:28:06 PM

Document Has Been Signed on 11/02/2021 01:28 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SWANER GUEST HOMEFACILITY NUMBER:
275294362
ADMINISTRATOR:ROSARIO MAGSAMBOLFACILITY TYPE:
740
ADDRESS:18615 SWANER AVENUETELEPHONE:
(831) 449-9379
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 6CENSUS: 6DATE:
11/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Matthew MagsambolTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Matthew Magsambol.

During visit, LPA Marrufo observed the facility to have a visitor screening area with screening questions for visitors and available hand sanitizer and cleaning supplies. LPA Marrufo observed the hallways and bathroom to have COVID-19 related signs. LPA Marrufo observed the facility PPE supplies and found the facility had a PPE supply of at least 30 days.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Matthew Magsambol and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
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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