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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
430708050
Report Date:
09/20/2022
Date Signed:
09/20/2022 02:01:33 PM
Document Has Been Signed on
09/20/2022 02:01 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:
TERRACES AT LOS ALTOS, THE
FACILITY NUMBER:
430708050
ADMINISTRATOR:
GONZALES, DEBORAH
FACILITY TYPE:
741
ADDRESS:
373 PINE LANE
TELEPHONE:
(650) 948-8291
CITY:
LOS ALTOS
STATE:
CA
ZIP CODE:
94022
CAPACITY:
250
CENSUS:
173
DATE:
09/20/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:45 PM
MET WITH:
Deborah Gonzales
TIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Deborah Gonzales.
The facility entrance had a visitor screening area. The facility bathrooms had available soap and paper towels. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days was observed. A 30-Day supply of PPEs were observed.
No deficiencies were cited at this time as per California Code of Regulations Title 22.
This report was reviewed with Administrator Deborah Gonzales and a copy of the report was provided.
SUPERVISOR'S NAME:
Sarah Yip
TELEPHONE:
(408) 324-2131
LICENSING EVALUATOR NAME:
David Marrufo
TELEPHONE:
(650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2022
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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