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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202115
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:09:55 PM

Document Has Been Signed on 10/12/2022 01:09 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:
10/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nilo AmbaganTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Nilo Ambagan.

During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo observed a visitor screening area. LPA Marrufo observed a 30-day supply of PPEs. LPA Marrufo observed a perishable food supply of 2 days and a non-perishable food supply of 7 days. LPA Marrufo observed cleaning supplies to be stored in locked storage areas. The facility hallway bathroom had available soap, paper towels, and hand washing signs. The outside exits were observed to be cleared of obstructions.

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

This report was reviewed with Nilo Ambagan and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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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