<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707831
Report Date: 03/06/2025
Date Signed: 03/10/2025 11:04:49 AM

Document Has Been Signed on 03/10/2025 11:04 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:LITTERAL HOUSEFACILITY NUMBER:
430707831
ADMINISTRATOR/
DIRECTOR:		CHRISTINA ROSSIFACILITY TYPE:
772
ADDRESS:96 SOUTH 14TH STREETTELEPHONE:
(408) 998-3293
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 15CENSUS: 15DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Christina RossiTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Administrator Christina Rossi.

During visit, LPA Marrufo toured the facility inside and out. LPA toured the food storage area in the basement. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA toured the kitchen area and observed a locked cabinet for knives and sharp utensils. LPA toured three out of three bathrooms and observed the water temperatures to be 106 F, 113 F, and 119 F. Each bathroom had available soap and paper towels.

LPA toured 5 out of 5 resident bedrooms. Each bedroom had available bedding and clothing storage areas and working lights.

LPA toured the outside area of the facility and observed the exits to be clear of obstructions.

LPA reviewed the Centrally Stored Medication and Destruction Records and resident records for six residents and found the records to be complete. LPA reviewed six staff records and found the records to be complete.

Facility records indicate that the fire alarm system passed its inspection on 01/06/2025 and the last emergency disaster drill was conducted on 03/04/2025. LPA tested the facility carbon monoxide detector and it functioned properly when tested.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Christina Rossi and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1