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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600883
Report Date: 05/20/2024
Date Signed: 05/20/2024 03:24:30 PM

Document Has Been Signed on 05/20/2024 03:24 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ROSEL'S HOMEFACILITY NUMBER:
415600883
ADMINISTRATOR/
DIRECTOR:		JOHN RUZZEL SKAGGSFACILITY TYPE:
735
ADDRESS:2033 OREGON AVENUETELEPHONE:
(650) 387-9488
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 4CENSUS: 4DATE:
05/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Administrator - Romar RaquinoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 05/20/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an uannounced case management - other visit in order to deliver letter of immediate exclusion regarding the previous administrator. LPA met with the current administrator Romar Raquino.

LPA provided the letter of exclusion to Romar and informed him what the letter is for regarding the previous administrator.

No citations issued.

Report reviewed with Romar.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
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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