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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 355202348
Report Date: 12/22/2023
Date Signed: 12/22/2023 11:15:51 AM

Document Has Been Signed on 12/22/2023 11:15 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
Lookup Error,
, CA
FACILITY NAME:CLEARVIEW CAREHOMES,INC.FACILITY NUMBER:
355202348
ADMINISTRATOR:FELICIDAD RAMOS KANKELBORGFACILITY TYPE:
740
ADDRESS:3370 CIENEGA ROADTELEPHONE:
(831) 637-4463
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 6CENSUS: 4DATE:
12/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator Felicidad Ramos KankelborgTIME COMPLETED:
11:30 AM
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Licensing Program Analyst's (LPA) Manuel Monter and Simi Rai conducted an unannounced case management visit. LPA's met with Administrator (ADM) Felicidad Ramos Kankelborg and explained the purpose of the visit was to deliver a letter of exclusion for facility staff S1. LPA's observed 2 staff and 4 residents during the visit.

LPA's Manuel Monter & Simi Rai hand delivered exclusion letter to ADM Felicidad Ramos Kankelborg.
LPA's Manuel Monter & Simi Rai hand delivered the exclusion letter to S1.

LPA's explained to ADM that S1 can no longer work at the facility at this time.

LPA's observed S1 vacate the facility.

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

This report was reviewed with Administrator Felicidad Ramos Kankelborg and a copy of the report was provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2023
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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