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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202115
Report Date: 10/11/2022
Date Signed: 10/11/2022 04:29:05 PM

Document Has Been Signed on 10/11/2022 04:29 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:FLINTCREST HOUSE IIFACILITY NUMBER:
435202115
ADMINISTRATOR:NILO AMBAGANFACILITY TYPE:
735
ADDRESS:3094 STEVENS LANETELEPHONE:
(408) 528-7734
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 6DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:49 PM
MET WITH:Salvacion BachoTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Salvacion Bacho.

During visit, LPA Marrufo toured the inside and outside of the facility. The facility entrance had a visitor screening area. There was a 30-day supply of PPEs. There was a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days. The facility hallway bathroom had available soap, paper towels, and hand washing signs. The outdoor exits were clear of obstructions.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Salvacion Bacho and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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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