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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202578
Report Date: 07/12/2024
Date Signed: 07/12/2024 05:07:27 PM

Document Has Been Signed on 07/12/2024 05:07 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:CEDAR MANOR LLCFACILITY NUMBER:
435202578
ADMINISTRATOR/
DIRECTOR:		CASIM, ELVIRAFACILITY TYPE:
735
ADDRESS:415 HEATH STREETTELEPHONE:
(408) 945-9197
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 5DATE:
07/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:35 PM
MET WITH:Staff Susan CasugaTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analyst Manuel Monter & Steve Chang conducted an unannounced case management to amend a complaint deficiency page's plan of correction. The LIC9099-D was issued on May 21, 2024.(26-AS-20230926161818.). LPA's explained the purpose of the visit.

Staff S1, Susan Casuga contacted house manger, Ronaldo Rapisura. House manager stated S1 could sign on his behalf.

No deficiencies cited during todays visit. This Report was reviewed with staff Susan Casuga. A signed copy was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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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