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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202191
Report Date: 07/31/2023
Date Signed: 08/01/2023 07:55:11 AM

Document Has Been Signed on 08/01/2023 07:55 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:NEWLIFE CARE SERVICES, INC. DBA NEWLIFE RCHFACILITY NUMBER:
435202191
ADMINISTRATOR:AMALIA AGUASFACILITY TYPE:
735
ADDRESS:4425 ADRAGNA COURTTELEPHONE:
(408) 832-3021
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 6CENSUS: 4DATE:
07/31/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Enrico AguasTIME COMPLETED:
04:56 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit, and met with Administrator (ADM) Enrico Aguas.

LPA obtained R1's physician report and Appraisal Need and Service Plan.

LPA interviewed Administrator (ADM) for R1's incident. ADM described what happened before the incident and the detail about the incident.

ADM provided the Police report case number. The case will need further investigation.

The 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: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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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