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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202917
Report Date: 03/21/2025
Date Signed: 03/21/2025 11:45:37 AM

Document Has Been Signed on 03/21/2025 11:45 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:ELLIE REESE CARE HOME LLCFACILITY NUMBER:
435202917
ADMINISTRATOR/
DIRECTOR:		OVISO, PORTIAFACILITY TYPE:
735
ADDRESS:3175 SYLVAN DRTELEPHONE:
(408) 891-7016
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 6DATE:
03/21/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Portia Oviso, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 03/21/2025 Licensing Program Analyst Marcela Yanez conducted an unannounced visit and met with Portia Oviso, Administrator. LPA announced the purpose of the visit. LPA observed 3 residents and 2 staff.

On 03/12/2025 LPA Yanez conducted a case management visit regarding incident report submitted to the department for R1 AWOL. LPA reviewed documentation for R1, Physicians report, IPP and Appraisal needs and services. LPA interviewed 2 staff.

on 03/21/2025 after careful review of all documents provided and interviews the AWOL was not an AWOL because resident is allowed to leave facility unassisted per physicians report dated 10/28/2024.

ADM stated any changes to residents ability to leave will be updated on physicians report and needs and services plan.

LPA determined the AWOL was not an AWOL. No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Administrator Portia Oviso and a copy of the report was provided
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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