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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202504
Report Date: 07/27/2022
Date Signed: 07/27/2022 12:35:29 PM


Document Has Been Signed on 07/27/2022 12:35 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:WEBSTER HOUSEFACILITY NUMBER:
435202504
ADMINISTRATOR:HIBBS, LINDAFACILITY TYPE:
741
ADDRESS:401 WEBSTER STREETTELEPHONE:
(650) 327-4333
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:54CENSUS: 28DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Ann LeeTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Ann Lee.

During visit, LPA Marrufo toured the inside and outside of the facility. The facility entrance had a visitor screening area with thermometer. LPA Marrufo observed the visitor bathroom and observed there to be available soap, paper towels, hand washing sign, and trash bin with foot-operated lid. LPA Marrufo observed there to be a PPE supply of at least 30 days. LPA Marrufo observed the kitchen area and observed there to be a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Ann Lee and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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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