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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202705
Report Date: 02/24/2025
Date Signed: 02/24/2025 10:36:38 AM

Document Has Been Signed on 02/24/2025 10:36 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:CRESCENT OAKSFACILITY NUMBER:
435202705
ADMINISTRATOR/
DIRECTOR:		JOSHUA LAMBENGCOFACILITY TYPE:
740
ADDRESS:147 CRESCENT AVETELEPHONE:
(408) 730-4004
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 44CENSUS: 39DATE:
02/24/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Geraldine Sabado, Activities DirectorTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On February 24, 2025, at 8:50 AM Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct an unannounced Proof of Correction (POC) visit. Upon arrival, the LPA was greeted by the Activities Director (AD), Geraldine Sabado. The LPA disclosed the purpose of the visit and was granted entry into the facility by the AD. The AD accompanied LPA during the inspection.

On 01/10/2025, the LPA conducted a Complaint Investigation visit at the facility. During the visit, the LPA observed a broken non-operational elevator. There was no other elevator available for the residents and staff to use. The deficiency was issued, and the plan of correction was developed with the licensee. The licensee stated that they would fix the elevator as soon as the part is delivered and submit the proof of fix with a video/photograph.

POC was due on 01/17/2025, but on 01/16/20225 the Executive Director (ED) asked for the first extension to 01/24/2025 and another extension to 01/31/2025, which were approved by the LPA. On 01/29/2025, LPA received an email from ED that the elevator had been fixed and was up and running. On 02/12/2025, LPA received an email from ED stating that the elevator was down for maintenance and required new circuit board. On 02/21/2025, LPA received an email from ED stating the elevator maintenance was completed and the elevator was operational again.

Today (02/24/2025) at 9:25 AM, LPA inspected the elevator in the presence of AD and observed the elevator was working and was operational for residents and staff to use. LPA observed that the permit posted in the elevator was old and had expired on 10/01/2020. LPA spoke to ED over the phone and ED stated they were in the process of scheduling the inspection and will email the proof of the new permit to CCLD once it was obtained. The deficiency 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times, issued on 01/10/2025, was cleared today.

No deficiencies were cited during today's visit.

An exit interview was conducted with the Activities Director. A copy of this report was left with the Activities Director, Geraldine Sabado, whose signature on this form confirms receipt of the report.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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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