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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440707795
Report Date: 07/26/2024
Date Signed: 07/26/2024 09:57:53 AM

Document Has Been Signed on 07/26/2024 09:57 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:ROLLING RIDGE R.C.H.FACILITY NUMBER:
440707795
ADMINISTRATOR/
DIRECTOR:		CARLONE, MICHAELFACILITY TYPE:
735
ADDRESS:751 LARKIN VALLEY ROADTELEPHONE:
(831) 475-0888
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 12CENSUS: 8DATE:
07/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Jesus RamirezTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Jesus Ramirez, staff.

The purpose of the visit was to deliver an Exclusionary Letter for staff S1. LPA Marrufo delivered the Exclusionary Letter to staff Jesus Ramirez during visit.

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

This report was reviewed with Jesus Ramirez and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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