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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200432
Report Date: 01/31/2023
Date Signed: 01/31/2023 02:16:39 PM

Document Has Been Signed on 01/31/2023 02:16 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:CARRANZA #1FACILITY NUMBER:
435200432
ADMINISTRATOR:CARRANZA, EDUARDOFACILITY TYPE:
735
ADDRESS:2052 LADDIE WAYTELEPHONE:
(408) 809-4715
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 6CENSUS: 6DATE:
01/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Eduardo CarranzaTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Eduardo Carranza.

During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo observed there to be a visitor screening area at the entrance. There was a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days. LPA Marrufo observed the resident bathroom had available soap, paper towels, and hand washing signs. LPA Marrufo observed a box of surgical masks, but no other Personal Protective Equipment (PPE) at the facility. The outside area was toured and the exterior exit was found to be clear of obstructions.

An Advisory Note was issued - see LIC9102 for more information.

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

This report was reviewed with Eduardo Carranza and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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