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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707808
Report Date: 08/23/2023
Date Signed: 08/23/2023 02:33:40 PM

Document Has Been Signed on 08/23/2023 02:33 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:HOPE REHABILITATION SERVICES - PARKMOORFACILITY NUMBER:
430707808
ADMINISTRATOR:JUAN GUELFACILITY TYPE:
775
ADDRESS:1555 PARKMOOR AVENUETELEPHONE:
(408) 282-0449
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 60CENSUS: DATE:
08/23/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Nga AuTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a collateral visit regarding a complaint investigation against facility #435202626.

LPA interviewed 2 staff members and 1 client.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Program Manager, Nga Au and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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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