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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
435200930
Report Date:
01/18/2024
Date Signed:
01/18/2024 10:32:48 AM
Document Has Been Signed on
01/18/2024 10:32 AM
- 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:
VI AT PALO ALTO
FACILITY NUMBER:
435200930
ADMINISTRATOR:
STEVE A. BRUDNICK
FACILITY TYPE:
741
ADDRESS:
620 SAND HILL ROAD
TELEPHONE:
(650) 853-5000
CITY:
PALO ALTO
STATE:
CA
ZIP CODE:
94304
CAPACITY:
876
CENSUS:
536
DATE:
01/18/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Valerie Alves
TIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Valerie Alves.
The purpose of the visit was to amend the LIC809 Case Management report from 12/28/2023.
No deficiencies were cited at this time as per California Code of Regulations Title 22.
This report was reviewed with Valerie Alves and a copy of this report was provided.
SUPERVISOR'S NAME:
Sarah Yip
TELEPHONE:
(408) 324-2131
LICENSING EVALUATOR NAME:
David Marrufo
TELEPHONE:
(650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE:
01/18/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/18/2024
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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