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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202919
Report Date: 05/02/2024
Date Signed: 05/02/2024 10:49:19 AM


Document Has Been Signed on 05/02/2024 10:49 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:VILLA TOSCANA A MEMORY CARE COMMUNITYFACILITY NUMBER:
435202919
ADMINISTRATOR:REYES, ALANAFACILITY TYPE:
740
ADDRESS:939 W. EL CAMINO REALTELEPHONE:
(707) 592-4252
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:70CENSUS: 0DATE:
05/02/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Grace SandovalTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) David Marrufo conducted a Prelicensing visit and met with Grace Sandoval, Executive Director.

During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo toured the kitchen area and observed the refrigerators and storage areas for food and supplies. LPA toured the facility exterior and observed the exits to be clear of obstructions. LPA observed the second and third floors of the facility and observed the medication rooms, activity rooms, and resident living areas.

During visit, LPA Marrufo reviewed the Component III presentation with Grace Sandoval, Executive Director.

Pre-Licensing is complete and this facility has no deficiencies.

This report was reviewed with Executive Director Grace Sandoval and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024
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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