Facility Evaluation Report

Good Samaritan Residential Care Facility, Hayward11/21/2025Licence 019200020

Capacity6
Census6
Date signed11/21/2025 01:29:44 PM
Name of licensing program analystPatricia Manalo
Name of licensing program managerYvonne Flores-Larios
The inspector’s account

On 11/21/2025 at 12:00 PM, Licensing Program Analyst (LPA) P. Manalo conducted a Health & Safety inspection as a result of Complaint #15-AS-20251120100911. LPA met with Administrator, Franklin Bautista and explained the purpose of the visit.

LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 115.5 degrees Fahrenheit. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Smoke detectors and carbon monoxide are in operating condition. First-aid kit was complete. Fire extinguisher was observed to be full and last purchased on 11/21/2025. There are no accessible bodies of water observed. Indoor and outdoor passageways are free of obstruction.

The following deficiencies were observed:

At 11:30 AM, LPA observed eggs in the kitchen drawer, eggroll with frostbite, spoiled salad, and expired cans.

At 12:08 PM, LPA observed Bisacodyl Suppository unlocked in the fridge.

At 12:10 PM, LPA observed baking soda and Lysol spray unlocked in the laundry room.

Deficiencies were cited per Title 22 California Code of Regulations (see Lic 809D).

Exit interview was conducted with Bautista. Copy of this report, Appeal Rights, and LIC421 was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction