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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708719
Report Date: 08/01/2024
Date Signed: 08/01/2024 12:35:41 PM


Document Has Been Signed on 08/01/2024 12:35 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:PRECIOUS MOMENTS RESIDENTIAL CARE HOME #2FACILITY NUMBER:
430708719
ADMINISTRATOR:RACHELLE REYNOLDSFACILITY TYPE:
740
ADDRESS:1701 FOXWORTHY AVENUETELEPHONE:
(408) 978-3173
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:6CENSUS: 0DATE:
08/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rachelle Reynolds AdministratorTIME COMPLETED:
12:30 PM
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On 8/1/2024 at 11:15 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced case management visit for facility closure.

At 11:20 a.m. LPA observed on-going construction, there was no sign of human activity and a container for construction refuse was observed parked on the driveway inside the locked gate.

LPA called the administrator (ADM) Rachelle Reynolds. ADM stated he/she will be at the facility within 10 to 15 minutes.

At 11:45 a.m. LPA with ADM toured the facility inside and outside and observed that no resident(s) were present at the facility. All residents have been relocated and the last resident moved out of the facility on 7/24/2024.

On 4/5/2024, Licensee sent out an email to notify resident's and family of the facility's closure. The facility stopped receiving clients upon notification to responsible parties of residents on April 6, 2024.

On 4/12/2024, licensee sent an email to LPA Chang of the decision to close the facility.
On 7/15/2024, Licensee sent a formal letter to Community Care Licensing (CCL) that the facility will be permanently closed on 8/2/2024. The facility is no longer in operation as of today's inspection.

No deficiency is being cited during today's visit per California Code of Regulation (CCR) Title 22. An exit interview was conducted with ADM Rachelle Reynolds. A copy of the report was provided.


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end of report
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2024
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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