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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850402
Report Date: 01/27/2025
Date Signed: 01/27/2025 10:16:39 AM

Document Has Been Signed on 01/27/2025 10:16 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:MONTEREY LODGEFACILITY NUMBER:
405850402
ADMINISTRATOR/
DIRECTOR:
HANER, GARRETTFACILITY TYPE:
740
ADDRESS:5255 MONTEREY ROADTELEPHONE:
(805) 226-7431
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 15CENSUS: 9DATE:
01/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:02 AM
MET WITH:Administrator, Garrett HanerTIME VISIT/
INSPECTION COMPLETED:
10:43 AM
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At 8:00am Licensing Program Analyst (LPA) Jeffries arrived announced to the facility to conduct the annual facility inspection. LPA met with facility administrator Garrett Haner-Tomasko announced who he is and the reason for the visit.

At 8:15am, Administrator and LPA conducted a walking tour of the facility. LPA observed at least two days of perishable foods and at least 7 days of nonperishable foods on hand for at least fifteen residents and staff. LPA noted that the facility was a comfortable 71 degrees (f). LPA tested the water temperature to be within regulation range of 105*-120* (f). LPA noted that all bedrooms are properly furnished and have the appropriate lighting and linin. LPA noted that this facility has a locked medcart located in the hallway of the facility. This facility is located on approximately 3 acres in a rural area. There is a gated complex with two identical facilities. This facility has 10 bedrooms and 12 bathrooms. Rooms are single and/or double occupancy which each of the 10 bedroom having a full privet bathroom, the other two bathrooms are resident, staff and visitor bathrooms that are in common areas. The facility has a sprinkler system and was pressure tested by Great Western Alarm on 10/11/2024. The carbon monoxides and smoke detectors are placed throughout the facility and are functioning properly. LPA observed 4 fire extinguishers placed throughout the facility all tested and in the green charge range. All passageways and exits are free and clear of debris. LPA noted that the residents were engaged in daily activities and there is an activity calendar posted on the wall. LPA noted that all regulated posting were posted on the hallways in a conspicuous and accessible area.

Administrator and LPA conducted a full review of the annual care tools modules. LPA noted that no technical, violation, or citation were noted on the full review of the annual care tools modules review and no violations or citations were issued a result of the facility walk through inspection. At this time there are no citations or violations as a result of the facility annual inspection.

Exit interview, report read, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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