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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294105
Report Date: 09/16/2022
Date Signed: 09/16/2022 04:09:40 PM


Document Has Been Signed on 09/16/2022 04:09 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:LEE'S CARE HOMEFACILITY NUMBER:
435294105
ADMINISTRATOR:CORAZON MILLARESFACILITY TYPE:
740
ADDRESS:5225 GALLANT FOX AVE.TELEPHONE:
(408) 841-9508
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:6CENSUS: 5DATE:
09/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Corazon MillaresTIME COMPLETED:
04:15 PM
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) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Corazon Millares.

During visit, the inside and outside of the facility were toured. The facility entrance had a visitor screening area. The facility bathroom had available soap and paper towels. Hand washing posters were posted in the bathroom. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days was observed. A 30-Day supply of PPEs were observed. Cleaning supplies were also observed.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Administrator Corazon Millares and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022
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