<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200308
Report Date: 08/27/2024
Date Signed: 08/27/2024 01:31:00 PM


Document Has Been Signed on 08/27/2024 01:31 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:MONTE-FARLEY MANOR GUEST HOMEFACILITY NUMBER:
435200308
ADMINISTRATOR:CARDONA, ELVIRA B.FACILITY TYPE:
740
ADDRESS:579 FARLEY STREETTELEPHONE:
(650) 967-1758
CITY:MT. VIEWSTATE: CAZIP CODE:
94043
CAPACITY:6CENSUS: 0DATE:
08/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Elvira CardonaTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) David Marrufo conducted a facility closure visit and met with Administrator (ADM) Elvira Cardona.

On 08/22/2024, ADM Cardona submitted a letter to the Department announcing the facility will be closing.

During visit, LPA Marrufo toured the facility and observed that there were no residents present. The bedrooms were observed to be empty of resident belongings.

ADM Cardona stated the last resident at the facility became deceased on 08/21/2024 and the facility no longer has any residents.

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

This report was reviewed with ADM Elvira Cardona and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1