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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294256
Report Date: 04/12/2023
Date Signed: 04/12/2023 02:03:15 PM


Document Has Been Signed on 04/12/2023 02:03 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:EASTRIDGE RESIDENTIAL CARE HOMEFACILITY NUMBER:
435294256
ADMINISTRATOR:MARY ROSE BAQUIRANFACILITY TYPE:
740
ADDRESS:2690 KEPPLER DRIVETELEPHONE:
(408) 274-4770
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY:6CENSUS: 0DATE:
04/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Licensee Mary Rose BaquiranTIME COMPLETED:
10:15 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 Analysts (LPAs) Simi Rai and Manuel Monter conducted an unannounced Case Management visit to conduct a facility closure tour. LPAs met with Licensee Mary Rose Baquiran.

LPAs toured the facility inside and out, including 6 out of 6 resident rooms. LPAs did not observe any residents to be present at the facility. During visit, LPAs obtained the original facility license. Licensee confirmed that all residents had been moved out of the facility as of 2/28/2023, and had previously submitted facility closure plan to the regional office on 03/1/2023. All previous residents were confirmed to have been relocated. The facility was observed as non operational.

No deficiencies were cited at this time as per California Code of Regulations Title 22. As of 04/12/2023, the facility license is no longer valid. LPA explained the closure process to licensee and provided licensee with a copy of this report.

This report was reviewed with Licensee Mary Rose Baquiran and a copy of the report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit RaiTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
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