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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202749
Report Date: 01/25/2024
Date Signed: 01/25/2024 03:23:44 PM


Document Has Been Signed on 01/25/2024 03:23 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:CARING HANDS RESIDENTIAL LIVING IIFACILITY NUMBER:
435202749
ADMINISTRATOR:OKORO, SYLVESTER OFACILITY TYPE:
740
ADDRESS:1324 BAGELY WAYTELEPHONE:
(614) 747-3443
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:6CENSUS: 3DATE:
01/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Staff Member Abijuan BurchellTIME COMPLETED:
11:30 AM
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On January 25, 2024 Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management visit and met with Staff Member (S1) Abijuan Burchell.

S1 called Administrator Sylvester Okoro. LPA explained to the ADM and S1 the purpose of the visit was to hand deliver a letter of exclusion for staff S2. Staff S2 was not in the facility during LPA's visit. ADM stated S2 never worked at the facility. A sealed letter with S2's exclusion letter was delivered.

LPA requested an updated LIC500, to be submitted by January 26, 2024

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Staff Member (S1) Abijuan Burchell and ADM Sylvester Okoro, via phone call, 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: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
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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