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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202949
Report Date: 07/22/2024
Date Signed: 07/22/2024 04:24:39 PM

Document Has Been Signed on 07/22/2024 04:24 PM - 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:GARDENIA HOMES 1 LLCFACILITY NUMBER:
435202949
ADMINISTRATOR/
DIRECTOR:		YONG, JOSEPHINEFACILITY TYPE:
740
ADDRESS:994 SOBRATO DRIVETELEPHONE:
(408) 375-7605
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 14CENSUS: 12DATE:
07/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Josephine YongTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted a follow up Pre-Licensing visit and met with Administrator Josephine Yong.

During visit, LPA Marrufo reviewed 4 staff records and 7 resident records and found them all to be complete. LPA observed the water flowing unobstructed in the bathroom sink that was clogged during the prior visit.

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

This report was reviewed with Administrator Josephine Yong and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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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