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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708114
Report Date: 08/29/2022
Date Signed: 08/29/2022 03:42:58 PM


Document Has Been Signed on 08/29/2022 03:42 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:VILLA SIENAFACILITY NUMBER:
430708114
ADMINISTRATOR:BERNARD,CORINEFACILITY TYPE:
740
ADDRESS:1855 MIRAMONTE AVENUETELEPHONE:
(650) 961-6484
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:77CENSUS: 67DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Justin BernardTIME COMPLETED:
03:53 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Marketing and Admissions Director Justin Bernard.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed there to be a visitor screening area, bathrooms with available soap and paper towels,as well as COVID-19 related hand washing posters, and a PPE supply of at least 30 days. LPA Marrufo observed the food supply of at least 2 days and a non-perishable food supply of at least 7 days. LPA Marrufo toured the outside of the facility and observed the exits to be clear of obstructions.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Justin Bernard and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022
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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