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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202853
Report Date: 12/12/2022
Date Signed: 12/12/2022 02:32:55 PM

Document Has Been Signed on 12/12/2022 02:32 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:EMANUEL'S CARE HOME #2FACILITY NUMBER:
435202853
ADMINISTRATOR:GONZALEZ, DORISFACILITY TYPE:
735
ADDRESS:6047 SAN YSABEL WAYTELEPHONE:
(408) 592-5303
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 4DATE:
12/12/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Doris GonzalezTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Post Licensing visit and met with Administrator Doris Gonzalez.

During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo observed there to be a 30-day supply of PPEs, a 3 day supply of perishable foods, and a 7 day supply of non-perishable foods. LPA Marrufo observed the bathrooms to have available soap. The outside area exits were free of obstructions. LPA Marrufo toured 3 out of 3 bedrooms and found them to have available bedding and lighting.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Doris Gonzalez and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2022
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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