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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202578
Report Date: 07/21/2022
Date Signed: 07/21/2022 10:47:27 AM

Document Has Been Signed on 07/21/2022 10:47 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:CEDAR MANOR LLCFACILITY NUMBER:
435202578
ADMINISTRATOR:CASIM, ELVIRAFACILITY TYPE:
735
ADDRESS:415 HEATH STREETTELEPHONE:
(408) 945-9197
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: DATE:
07/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Attempted VisitTIME COMPLETED:
10:47 AM
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Licensing Program Analyst Ryker Heberle (LPA) attempted to conduct an annual inspection at the facility. LPA arrived at 09:58am, but nobody answered when LPA rang the door bell and knocked. LPA attempted to call the administrator at their cell phone number, but was unable to make contact. LPA left a message with administrator, and attempted to call one additional time. LPA circled the property and determined that nobody was currently at the facility. By 10:45am, LPA had not received a call back from the administrator, and opted to return at another time.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Ryker Heberle
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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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