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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201736
Report Date: 02/13/2024
Date Signed: 02/13/2024 05:28:56 PM

Document Has Been Signed on 02/13/2024 05:28 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:ABORN ADULT CARE HOMEFACILITY NUMBER:
435201736
ADMINISTRATOR:ARIELLE TEODOROFACILITY TYPE:
735
ADDRESS:2868 ABORN ROADTELEPHONE:
(408) 223-1108
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 6CENSUS: 6DATE:
02/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Adminstrator ARIELLE TEODOROTIME COMPLETED:
05:35 PM
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Licensing Program Analyst Manuel conducted an unannounced case management visit to amend a complaint investigation LIC9099, LIC9099-C and LIC9099-D issued on February 10, 2024, .(26-AS-20240209105051) due to additional information.

LPA met with Administrator Arielle Teodoro and explained the purpose of the visit.

A technical violation is being given.
No deficiencies cited. A copy of the report was provided to ADM Arielle Teodoro.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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