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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294175
Report Date: 07/03/2023
Date Signed: 07/03/2023 09:18:31 AM


Document Has Been Signed on 07/03/2023 09:18 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:MONROE RESIDENTIAL CARE HOMEFACILITY NUMBER:
435294175
ADMINISTRATOR:ROJAS JR, VICENTE P.FACILITY TYPE:
740
ADDRESS:673 N. MONROE STREETTELEPHONE:
(408) 243-1135
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:6CENSUS: 0DATE:
07/03/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Vicente RojasTIME COMPLETED:
09:20 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived to the facility announced to conduct a facility closure visit. LPA met with Licensee, Vicente Rojas.

During visit, LPA toured the facility to include the living room, resident rooms, bathrooms, kitchen, garage, and backyard.

There were no residents in care at the facility and operations have ceased.

Licensee, Vicente Rojas surrendered the facility license.

The effective closure date is July 1, 2023.

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

This report was reviewed with Licensee, Vicente Rojas and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023
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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