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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202954
Report Date: 02/13/2025
Date Signed: 02/13/2025 08:44:59 AM

Document Has Been Signed on 02/13/2025 08:44 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:FARAVIZ RESIDENTIAL CARE HOME LLCFACILITY NUMBER:
435202954
ADMINISTRATOR/
DIRECTOR:		EBADAT, HASSANFACILITY TYPE:
735
ADDRESS:6041 FOOTHILL GLEN DRIVETELEPHONE:
(669) 273-3326
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 0DATE:
02/13/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Faraviz FoshatiTIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) David Marrufo conducted a Pre-Licensing Visit and met with Faraviz Foshati, Licensee, and Administrator Hasan Ebadat.

During visit, LPA observed that the following changes had been made according to the requested updates from the visit on 01/15/2025:
- Personal belongings in resident rooms had been removed
- Personal belongings of an individual living in the storage area had been removed. The individual was also not present.
- Locks were added to cabinets in the kitchen and laundry room to store cleaning supplies.
- Locks were added to cabinets in the kitchen to store medication.
- Facility records will be stored in the locked storage room.
- The secondary external gate was removed.
- The primary external gate was unlocked.
- The facility floor plan was updated to reflect that the facility garage has been modified and converted into a storage area.

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

This report was reviewed with Faraviz Foshati, Licensee, and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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