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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700017
Report Date: 07/08/2022
Date Signed: 07/08/2022 12:34:22 PM

Document Has Been Signed on 07/08/2022 12:34 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 # 1FACILITY NUMBER:
430700017
ADMINISTRATOR:CHERALYNN SABANKAYAFACILITY TYPE:
735
ADDRESS:260 SOUTH 11TH STREETTELEPHONE:
(408) 289-1644
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 38CENSUS: 29DATE:
07/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Renee SabankayaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced required 1 year visit and met with Renee Sabankaya.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed 2 out of 2 hallway bathrooms and observed available soap and hand washing signs. LPA Marrufo toured the kitchen area and basement food storage area and observed there to be a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days. LPA Marrufo observed a PPE supply of at least 30-days. LPA Marrufo observed that the facility did not have a visitor screening area and staff S1 confirmed that there was no visitor screening area.

An advisory note was issued. See LIC9102 for more information. No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Renee Sabankaya and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2022
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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