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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202705
Report Date: 05/31/2024
Date Signed: 05/31/2024 04:07:38 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/31/2024 04:07 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:CRESCENT OAKSFACILITY NUMBER:
435202705
ADMINISTRATOR:JOSHUA LAMBENGCOFACILITY TYPE:
740
ADDRESS:147 CRESCENT AVETELEPHONE:
(408) 730-4004
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:44CENSUS: 42DATE:
05/31/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Joshua LambengcoTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management - Annual Continuation visit and met with Administrator Joshua Lambengco.

During visit, LPA Marrufo reviewed 5 staff records and found them to be complete.

LPA Marrufo toured the kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least 7 days.

LPA Marrufo toured the garage area and observed the locked storage rooms for cleaning supplies.

LPA Marrufo observed 1 out of 1 hallway bathrooms and observed the water temperature to be at 111 F. The bathroom had working lights and available soap and paper towels.

LPA Marrufo observed 7 resident bedrooms and observed each bedroom to have working lights and available bedding and clothing storage areas.

LPA Marrufo toured the facility exits and found them to be clear of obstructions.

LPA Marrufo requests that the smoke detector inspection logs and emergency disaster drill logs be submitted to CCL by 06/05/2024.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Joshua Lambengco and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
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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