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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
430700017
Report Date:
02/02/2024
Date Signed:
02/02/2024 04:25:57 PM
Document Has Been Signed on
02/02/2024 04:25 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
CENTRAL COAST CR/RES
,
2580 N. FIRST STREET, STE. 350
SAN JOSE
,
CA
95131
FACILITY NAME:
ALI BABA # 1
FACILITY NUMBER:
430700017
ADMINISTRATOR:
CHERALYNN SABANKAYA
FACILITY TYPE:
735
ADDRESS:
260 SOUTH 11TH STREET
TELEPHONE:
(408) 289-1644
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95112
CAPACITY:
38
CENSUS:
30
DATE:
02/02/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Maria Canizales
TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Program Director Maria Canizales.
The purpose of the visit was to amend a complaint report from a visit on 08/15/2023.
No deficiencies were cited at this time as per California Code of Regulations Title 22.
This report was reviewed with Program Director Maria Canizales and a copy of the report was provided.
SUPERVISORS NAME
:
Sarah Yip
LICENSING EVALUATOR NAME
:
David Marrufo
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/02/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/02/2024
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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