<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202928
Report Date: 12/18/2024
Date Signed: 12/18/2024 09:15:56 AM

Document Has Been Signed on 12/18/2024 09:15 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:LIFE SERVICES ALTERNATIVES INC SPRING AVENUE HOMEFACILITY NUMBER:
435202928
ADMINISTRATOR/
DIRECTOR:		FERRER, ORLANDOFACILITY TYPE:
735
ADDRESS:170 SPRING AVENUETELEPHONE:
(408) 727-3493
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 5CENSUS: 0DATE:
12/18/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Orlando FerrerTIME VISIT/
INSPECTION COMPLETED:
09:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christine Dolores arrived announced to conduct the pre-licensing visit follow-up. LPA met with Orlando Ferrer (Administrator).

During visit, LPA observed the mirrors above the sink in the hallway bathroom and bedroom #1 bathroom is more sturdy. LPA was unable to move the mirror on the wall. The showers inside bedroom #1 and bedroom #2 contains grab bars.

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 Orlando Ferrer and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1