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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202267
Report Date: 03/06/2025
Date Signed: 03/06/2025 10:13:58 AM

Document Has Been Signed on 03/06/2025 10:13 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:NATHAN'S RESIDENTIAL CARE HOME, INC.FACILITY NUMBER:
435202267
ADMINISTRATOR/
DIRECTOR:		STEPHANIE VALERAFACILITY TYPE:
735
ADDRESS:7315 WREN AVENUETELEPHONE:
(408) 847-6441
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 6CENSUS: 5DATE:
03/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Stephanie ValeraTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Christine Kabariti arrived at the facility unannounced to conduct a case management – other visit. LPA met with Administrator Stephanie Valera.

The purpose of the visit is to hand deliver an immediate exclusion letter for a staff member (S1) who the Department determined engaged in conduct inimical.

The immediate exclusion letter for S1 was handed to the Administrator.

Administrator confirmed S1 does not currently work for the facility. The Administrator was informed to remove S1 from any contact with clients and not allow S1 to be physically present in the facility.

LPA advised to separate S1 from the facility roster.

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

This report was reviewed with Administrator Stephanie Valera and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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