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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202396
Report Date: 02/19/2025
Date Signed: 02/19/2025 04:09:36 PM

Document Has Been Signed on 02/19/2025 04:09 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:EBADAT RESIDENTIAL CARE HOME #1FACILITY NUMBER:
435202396
ADMINISTRATOR/
DIRECTOR:		GLEEN MESAFACILITY TYPE:
735
ADDRESS:163 PARK DARTMOUTH PL.TELEPHONE:
(408) 225-5721
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 6CENSUS: DATE:
02/19/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:39 PM
MET WITH:Gleen MesaTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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
Licensing Program Analyst (LPA) Conducted an unannounced Plan of Correction visit to follow up the case management conducted on 12/11/2024, and met with Administrator (ADM) Gleen Mesa.

The facility was cited as Title 22 section 80086(a) Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change. On 12/12/2024, the Department received the plan of correction sent by ADM.

On 2/18/2025, the Department received Fire Clearance for the facility's new construction/alteration.

LPA toured the facility with ADM. The facility has 4 resident bedrooms, 2 staff rooms, 3 bathrooms, living room, family room, kitchen, dining area, and laundry room.

No citation noted for today's visit.

Exit interview was conducted with ADM. The report was provided to ADM for review and signature. A copy of the report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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