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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440708908
Report Date: 02/14/2025
Date Signed: 03/03/2025 02:25:55 PM

Document Has Been Signed on 03/03/2025 02:25 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:WESLEY HOUSE IIFACILITY NUMBER:
440708908
ADMINISTRATOR/
DIRECTOR:
LEON, JANETFACILITY TYPE:
740
ADDRESS:121 LA SELVA DRIVETELEPHONE:
(831) 685-0646
CITY:LA SELVA BEACHSTATE: CAZIP CODE:
95076
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Janet LeonTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Janet Leon.

During visit, LPA toured the facility inside and out. LPA toured the facility kitchen and food storage areas and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the facility first aid kit and found it to be complete.

LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured at 109 F and 110 F.

LPA toured three out of three resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA tested the smoke and carbon monoxide detectors in the hallway and resident rooms, and all smoke and carbon monoxide detectors functioned properly when tested.

LPA toured the outside area and found the outdoor exit to be clear of obstructions.

LPA reviewed three out of three resident records, including Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed five staff records and found them to be complete.

LPA reviewed the Emergency Disaster Drill Log, which indicated that the last emergency disaster drill was conducted on 11/05/2024.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Janet Leon and a copy of this report was provided.
Sarah YipTELEPHONE: (408) 324-2131
David MarrufoTELEPHONE: (650) 380-0519
DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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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