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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202916
Report Date: 01/22/2024
Date Signed: 01/22/2024 11:50:38 AM

Document Has Been Signed on 01/22/2024 11:50 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:CROSSROADS AT 650 SOUTH BASCOMFACILITY NUMBER:
435202916
ADMINISTRATOR:HARBIN, KAREEBFACILITY TYPE:
735
ADDRESS:650 S BASCOM AVETELEPHONE:
(669) 319-2410
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 28CENSUS: 0DATE:
01/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Kareeb HarbinTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived announced to conduct the pre-licensing follow-up visit from 01/18/2024. LPA met with Kareeb Harbin and Eleanor Sosa-Pace.

During visit, LPA measured the hot water temperature. The women’s bathroom hot water temperature is maintained at 106 degrees Fahrenheit. The men’s bathroom hot water temperature is maintained at 106 degrees Fahrenheit.

Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete.

LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

This report was reviewed with Kareeb Harbin and Eleanor Sosa-pace and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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