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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202726
Report Date: 01/09/2024
Date Signed: 01/09/2024 12:39:00 PM


Document Has Been Signed on 01/09/2024 12:39 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:CHERRY VILLAFACILITY NUMBER:
435202726
ADMINISTRATOR:PAREDES, FREDERICFACILITY TYPE:
740
ADDRESS:2604 CHERRY AVETELEPHONE:
(408) 802-0215
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:0CENSUS: 0DATE:
01/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Administrator Frederic ParedesTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPAs) Manuel Monter and Steve Chang conducted an unannounced Case Management visit to conduct a facility closure tour. LPAs met with Administrator (ADM) Frederic Paredes.

LPAs toured the facility inside and out, including resident rooms. LPAs did not observe any residents to be present at the facility. ADM confirmed that all residents had been moved out of the facility as of December 31, 2023, and had previously submitted facility closure plan to the regional office on December 14, 2023. All previous residents were confirmed to have been relocated. The facility was observed as non operational.

No deficiencies were cited at this time as per California Code of Regulations Title 22. As of January 1 2024, the facility license is no longer valid.

This report was reviewed with ADM Frederic Paredes and a copy of the report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
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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