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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201751
Report Date: 02/14/2025
Date Signed: 02/14/2025 01:29:45 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/14/2025 01:29 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:RICHARDS MANOR IVFACILITY NUMBER:
435201751
ADMINISTRATOR/
DIRECTOR:		SHIRLEY RICHARDSFACILITY TYPE:
735
ADDRESS:4392 CLEARPARK PLACETELEPHONE:
(408) 281-2334
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 6CENSUS: 0DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Shirley RichardsTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit. Upon arrival, a female Daisy Consulta (DC) opened the door for LPA. DC stated the facility is in a non operational status, and there is no resident in facility.

Administrator (ADM) Shirley Richards arrived at the facility 10 minutes after LPA entered the facility.

LPA toured the facility inside and out with ADM. Living room, family room, dining room, kitchen, and garage were inspected. 3 restrooms, 1 office, 4 bedrooms, and 1 master bedroom were observed in the facility.

LPA toured the backyard, no obstruction was observed to block walkway.

No resident was observed in facility or at the backyard.

The house is in non operational status.

LPA suggested ADM to close the facility if the facility is in non operational status.

Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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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