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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202172
Report Date: 10/12/2022
Date Signed: 10/12/2022 11:41:38 AM

Document Has Been Signed on 10/12/2022 11:41 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:STURLA CARE HOMEFACILITY NUMBER:
435202172
ADMINISTRATOR:DUMANTAY, MARJORIEFACILITY TYPE:
735
ADDRESS:2644 STURLA DRTELEPHONE:
(408) 818-0134
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 6DATE:
10/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Ross MaderaTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Ross Madera.

During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo observed a visitor screening area. A PPE supply of at least 30 days was observed. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days were observed. Cleaning supplies were observed to be stored in locked storage.

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

This report was reviewed with Ross Madera 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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