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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201737
Report Date: 02/03/2023
Date Signed: 02/03/2023 10:58:44 AM

Document Has Been Signed on 02/03/2023 10:58 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:HILLSIDE RANCH CORPORATIONFACILITY NUMBER:
435201737
ADMINISTRATOR:APOSTOL, OBEDFACILITY TYPE:
735
ADDRESS:2320 SHAFER AVENUETELEPHONE:
(408) 930-9872
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 6CENSUS: 6DATE:
02/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Obed ApostolTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Licensee, Obed Apostol.

The purpose of the visit was to observe the separate building at the facility.

No residents observed on-site and were attending day program. During visit, LPA toured the facility with Licensee to include the exterior, backyard, staff room, laundry room, garage, resident rooms, bathrooms, and kitchen. All fire exits were free and clear of obstruction.

LPA observed the staff living quarters, laundry room, and garage space. The live-in staff are fingerprint cleared and associated to the facility. The facility sketch matches LPAs observations. There are no persons living in the garage.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Licensee, Obed Apostol and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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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