<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202154
Report Date: 03/08/2024
Date Signed: 03/08/2024 10:48:33 AM

Document Has Been Signed on 03/08/2024 10:48 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:MISSION BAY, INC.FACILITY NUMBER:
435202154
ADMINISTRATOR:MARIA COKERFACILITY TYPE:
775
ADDRESS:980 RINCON CIR.TELEPHONE:
(408) 433-3303
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY: 135CENSUS: 117DATE:
03/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Program Director Raul Regencia and Marion Cookie Cozine Assistant Program Director TIME COMPLETED:
10:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On March 8, 2024, Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management visit and met with Program Director Raul Regencia and Marion Cookie Cozine Assistant Program Director

The purpose of the visit is to deliver an immediate exclusion letter for staff S1. S1 is not allowed to be physically present in this facility (to work and volunteer).

Program Director stated S1 does not work at the facility. Program director provided LPA with a copy of the facility LIC500.

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

This report was reviewed with Program Director Raul Regencia and Marion Cookie Cozine Assistant Program Director , via phone call, and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1