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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200298
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:43:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/04/2023 01:43 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:JENNISON CAREFACILITY NUMBER:
435200298
ADMINISTRATOR:NOLASCO, ROSITA D.FACILITY TYPE:
740
ADDRESS:878 NIEVES STREETTELEPHONE:
(408) 262-5878
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:6CENSUS: 0DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jennifer BaternaTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted a Required - 1 Year visit and met with Jennifer Baterna. Prior to the visit, the administrator, Rosita Nolasco, had reported to the Department that she had closed her facility and all the residents had already moved out.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed that there were no residents present at the facility. LPA Marrufo observed the facility bedrooms were clear of beds, drawers, and personal belongings.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Jennifer Baterna 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: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
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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