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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200605
Report Date: 03/21/2025
Date Signed: 03/21/2025 12:40:01 PM

Document Has Been Signed on 03/21/2025 12:40 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:ATRIA WILLOW GLENFACILITY NUMBER:
435200605
ADMINISTRATOR/
DIRECTOR:		GURSU, UGUR (KURT)FACILITY TYPE:
740
ADDRESS:1660 GATON DRTELEPHONE:
(408) 266-1660
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 63TOTAL ENROLLED CHILDREN: 0CENSUS: 47DATE:
03/21/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Administrator Ugur (Kurt) GursuTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On March 21, 2025, Licensing Program Analyst Manuel Monter conducted an unannounced POC visit. LPA met with Administrator (ADM) Ugur (Kurt) Gursu. LPA explained the purpose of the visit.

On January 2, 2025, the facility was cited the following type A deficiencies, regarding an elopement that occurred on September 11, 2024, with the POC due of January 3, 2025.

87468.1 Personal Rights: (a)(2) & 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4)

On January 3, 2025, the Department received plan of corrections and cleared plan of corrections on January 3, 2025.

On March 21, 2025, LPA conducted a POC visit to ensure the plan of corrections are being followed.
LPA observed staff training records which included but not limited to:
Elopement drills, Interventions and redirecting techniques for residents with wandering behaviors, Quarterly safety training.

LPA received copies of the documentation of training and drills.

No deficiencies cited during today's visit. This report was reviewed with Administrator Ugur (Kurt) Gursu and a copy of the signed report was provided.
Romeo ManzanoTELEPHONE: (408) 388-2297
Manuel MonterTELEPHONE: (408) 324-2112
DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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