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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601119
Report Date: 01/10/2024
Date Signed: 01/19/2024 09:39:15 AM


Document Has Been Signed on 01/19/2024 09:39 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CYPRESS HOMEFACILITY NUMBER:
415601119
ADMINISTRATOR:ALEJANDRO, VICTORIAFACILITY TYPE:
740
ADDRESS:537 CYPRESS ST.TELEPHONE:
(510) 326-6759
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:4CENSUS: 0DATE:
01/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:NATIME COMPLETED:
03:30 PM
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On 01/10/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection visit. LPA did not meet with anyone at time of visit due to the facility being vacant and not operational at this time due to a fire that occurred on 02/22/2023.

LPA observed that the front of the facility and it looks in place. Main windows facing the street are in place. Front door windows are blacked out. The side gate on the south side is observed as being replaced with pressed wood. LPA observed that there is a blue tarp covering the back part of the roof of the facility. Side gate to the north is pad locked. Windows are observed on the south side as covered with wood. No answer when door knocks are made. No lights or other activity can be viewed through the windows that are observable from the outside of the facility. Per contact with the administrator Victoria Alejandro the facility is still not in operation and there are no residents in care. The facility is vacant and doesn't know the status of the facility and when they will be re opened at this time.

This facility is vacant.

No one on site to conduct report review.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024
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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