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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200153
Report Date: 12/11/2024
Date Signed: 12/11/2024 05:30:58 PM

Document Has Been Signed on 12/11/2024 05:30 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:OCAMPO RCH #2FACILITY NUMBER:
435200153
ADMINISTRATOR/
DIRECTOR:		OCAMPO, CARLITO & RAQUELFACILITY TYPE:
735
ADDRESS:1511 PADRES COURTTELEPHONE:
(408) 295-3094
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 6CENSUS: 5DATE:
12/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:40 PM
MET WITH:Administrator Carlito OcampoTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management- Deficiencies visit. LPA met with Administrator (ADM) Carlito Ocampo. LPA explained the purpose of the visit. During the visit, LPA observed 5 residents and 3 staff.

The purpose of the visit is regarding to deficiencies cited on November 7, 2024 and to verify that the plan of corrections are being followed. The following are the some of the deficiencies cited that are being inspected today which included the following;
1. Facility Water Temperature for Faucets used by residents.
2. Resident P&I records

LPA tested water temperature in both resident bathroom, which ranged from 118-119 degree's F.
LPA reviewed 3 resident P&I records. ADM also sent documentation of training regarding P&I records to LPA by POC date.

No deficiencies cited during today's visit. This report was reviewed with Administrator Carlito Ocampo and a copy of the signed report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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