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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
435202616
Report Date:
01/14/2025
Date Signed:
01/14/2025 04:36:19 PM
Document Has Been Signed on
01/14/2025 04:36 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:
KEENE KARE
FACILITY NUMBER:
435202616
ADMINISTRATOR/
DIRECTOR:
GAMBOA, ABIGAIL
FACILITY TYPE:
740
ADDRESS:
2488 GLEN ELM WAY
TELEPHONE:
(408) 531-9678
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95148
CAPACITY:
6
TOTAL ENROLLED CHILDREN:
0
CENSUS:
0
DATE:
01/14/2025
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:
Abigail Gamboa
TIME VISIT/
INSPECTION COMPLETED:
04:09 PM
NARRATIVE
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management visit to conduct a facility closure tour. LPA met with Administrator ADM) Abigail Gamboa.
LPA toured the facility inside and out. LPA did not observe any resident at the facility. The facility was observed at a non-operational status.
ADM submitted the original license.
No deficiency was cited during today's visit. LPA explained the closure process to ADM.
Exit interview was conducted with ADM. The report was provided to ADM for review and signature. A copy of the report was provided to ADM.
Romeo Manzano
TELEPHONE:
(408) 277-1289
Chihhsien Chang
TELEPHONE:
(408) 904-9843
DATE:
01/14/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/14/2025
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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