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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202271
Report Date: 10/15/2024
Date Signed: 10/15/2024 12:51:02 PM


Document Has Been Signed on 10/15/2024 12:51 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:NOOR ACTIVE LIVINGFACILITY NUMBER:
435202271
ADMINISTRATOR:NAZILA SAFARIFACILITY TYPE:
740
ADDRESS:1818 SCOTT BLVD.TELEPHONE:
(408) 380-4036
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:32CENSUS: 0DATE:
10/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Nazila SafariTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Manuel Monter and Marcela Yanez conducted a facility closure visit and met with Administrator (ADM) Nazila Safari

On September 9, 2024, ADM Nazila Safari submitted a letter to the Department announcing the facility will be closing.

During visit, LPA's toured the facility and observed that there were no residents present. LPA's observed resident bedroom as empty, with no resident belongings. ADM confirmed that all residents had been moved out of the facility as of October 12, 2024. ADM provided original licensee to LPA's.

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

This report was reviewed with Administrator Nazila Safari and a copy of this report was provided. LPA informed ADM that she could complete the closure survey once received.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024
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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