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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202927
Report Date: 09/12/2024
Date Signed: 09/12/2024 10:18:00 AM

Document Has Been Signed on 09/12/2024 10:18 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:CASA DE REYESFACILITY NUMBER:
435202927
ADMINISTRATOR/
DIRECTOR:
MIRANDA, LEOFELMAFACILITY TYPE:
735
ADDRESS:7566 ALEXANDER STREETTELEPHONE:
(408) 848-6672
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 6CENSUS: 5DATE:
09/12/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Leofelma MirandaTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's post-licensing inspection. LPA met with Administrator (ADM) Leofelma Miranda.

This was a change in ownership and the facility's license is effective as of 06/17/2024. The facility is currently pending vendorization with the San Andreas Regional Center.

No clients observed on site and were all attending day program. LPA toured the facility with the ADM to include the living room, resident bedrooms, bathrooms, kitchen, laundry room, and backyard. All fire exits were free and clear of obstruction. Facility temperature maintained at 71 degrees F. Resident bedrooms equipped with bedding, linens, dresser, night stand, closet space and adequate lighting. Kitchen equipped with 2 days worth of perishables and 7 days worth of non-perishables. Facility is equipped with fire extinguisher and carbon monoxide.

All the facility's records to include the signs posted in the hallways are currently labeled as "Miranda's Residential Care Home". Administrator states they are waiting for the vendorization for this facility, which is why they have not updated the facility's records. Administrator states they will update all the records to include staff records and client records to "Casa De Reyes" by 09/27/2024.

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

This report was reviewed with Administrator, Leofelma Miranda and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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