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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202786
Report Date: 02/03/2023
Date Signed: 02/03/2023 03:23:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/03/2023 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:LEARNING SERVICES CORPORATION - MESA HOUSEFACILITY NUMBER:
435202786
ADMINISTRATOR:ABRAHAM LONGORIAFACILITY TYPE:
735
ADDRESS:5672 MESA ROADTELEPHONE:
(408) 848-4379
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 4CENSUS: 0DATE:
02/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Abraham LongoriaTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Administrator, Abraham Longoria.

LPA toured the facility to include the living room, kitchen, bedrooms, bathroom, garage, and exterior. All fire exit routes are free and clear of obstruction. The fire extinguisher was last serviced in June 2022.

There are no residents or persons currently residing in the facility. Residents has been transferred to Learning Service Corporation South Valley Ranch #1 and South Valley Ranch #2 due to the low census since November 2021. Facility remains open and may be operational, if needed.

LPA observed the facility has Personal Protective Equipment (PPE) supplies.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Abraham Longoria and a copy of the report will be emailed to the Administrator due to printer issues.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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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