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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202472
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:18:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/11/2025 03:18 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:LUXURY VILAFACILITY NUMBER:
435202472
ADMINISTRATOR/
DIRECTOR:		MR. CYRIL INNEHFACILITY TYPE:
735
ADDRESS:27/41 SOUTH 11TH STREETTELEPHONE:
(408) 903-3151
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 39CENSUS: 0DATE:
03/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Cyril InnehTIME VISIT/
INSPECTION COMPLETED:
03:30 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) David Marrufo conducted an unannounced Required 1 Year visit and met with Cyril Inneh.

During visit, LPA Marrufo observed that the front door, front windows, and driveway gate of the facility had particle board covering them. Administrator Cyril Inneh stated that the residents of the facility had been moved out on April 2022 and the facility is currently undergoing renovations. Administrator Inneh stated that there are currently no residents living at the facility.

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

This report was reviewed with Administrator Inneh and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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