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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202528
Report Date: 09/12/2022
Date Signed: 09/12/2022 10:40:28 AM

Document Has Been Signed on 09/12/2022 10:40 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:JULIETTE'S GARDENS (ROSE)FACILITY NUMBER:
435202528
ADMINISTRATOR:PEREZ, JONATHANFACILITY TYPE:
740
ADDRESS:1511 ILIKAI AVETELEPHONE:
(408) 393-3882
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY: 6CENSUS: 5DATE:
09/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Jonathan PerezTIME COMPLETED:
10:50 AM
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 Analysts (LPAs) David Marrufo and Simi Rai conducted an unannounced Required 1 Year visit and met with Administrator Jonathan Perez.

During visit, LPAs toured the inside and outside of the facility. LPAs observed a visitor screening area at the entrance. LPAs observed the hallway bathroom to have available soap and paper towels as well as hand washing signs. LPAs observed a 30-day supply of PPEs. The outdoor area exit was clear of obstructions.

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

This report was reviewed with Administrator Jonathan Perez and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2022
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