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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415202881
Report Date: 05/09/2024
Date Signed: 05/09/2024 10:59:28 AM

Document Has Been Signed on 05/09/2024 10:59 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:TELECARE POPLAR HOUSEFACILITY NUMBER:
415202881
ADMINISTRATOR/
DIRECTOR:		FLORES, AUSTIN KFACILITY TYPE:
737
ADDRESS:2299 POPLAR AVETELEPHONE:
(650) 352-6588
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 4CENSUS: 0DATE:
05/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Austin FloresTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) David Marrufo conducted a Pre-Licensing visit and met with Administrator Austin Flores.

During visit, LPA Marrufo toured the facility inside and out. The facility kitchen had locked storage areas for cleaning supplies and sharp objects.

Two out of two resident bathrooms had available soap, paper towels, and functioning lights. The water temperatures in the bathroom sinks were 118 F and 116 F.

LPA Marrufo observed a locked medication cart and locked storage areas for resident and personnel records.

LPA Marrufo toured four out of four bedrooms and observed each bedroom had a bed with bedding, drawers and clothing storage areas, and functioning lights. The smoke and carbon monoxide detectors in each room functioned properly when tested.

LPA Marrufo reviewed the Component III presentation with Administrator Austin Flores.

Pre-Licensing is complete and this facility has no deficiencies.

This report was reviewed with Administrator Austin Flores and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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