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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294340
Report Date: 11/19/2020
Date Signed: 11/19/2020 10:08:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MOLDAW FAMILY RESIDENCES AT 899 CHARLESTONFACILITY NUMBER:
435294340
ADMINISTRATOR:ELYSE GERSONFACILITY TYPE:
741
ADDRESS:899 EAST CHARLESTON ROADTELEPHONE:
(650) 433-3600
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:270CENSUS: 218DATE:
11/19/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Elyse GersonTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit over telephone and spoke with Elyse Gerson, Administrator. The visit was conducted over telephone due to the ongoing COVID-19 Shelter-in-Place order.

The purpose for the visit was to investigate whether the facility has permitted construction crews and film crews into the facility. During interview, Administrator Elyse Gerson stated that the facility's corporate office has not sent in construction crews or film crews today and does not plan on doing so tomorrow. Administrator Gerson explained that there are plans to expand the Charleston Terrace Meeting Room at the facility, and surveyors were originally planned on being sent to the facility to inspect the room, but they have not been allowed into the facility. Administrator reports that she has spoken with Santa Clara County Department of Public Health officials and they have stated verbally that non-essential, non-medical visitors are not permitted to be allowed into the facility at this time, including construction workers.

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

This report was reviewed with Administrator Elyse Gerson. A copy of this report will be sent to Elyse Gerson so that she may sign and return it to CCL.
SUPERVISOR'S NAME: George NwaforTELEPHONE: (408) 324-2116
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2020
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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