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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445200496
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:38:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:WESLEY HOUSE IVFACILITY NUMBER:
445200496
ADMINISTRATOR:LEON, JANETFACILITY TYPE:
740
ADDRESS:922 BREWINGTON AVENUETELEPHONE:
(831) 761-2220
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:6CENSUS: 0DATE:
12/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Janet LeonTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to conduct a facility closure visit. LPA met with Janet Leon Administrator/Licensee and toured the facility inside and out. There were no residents in care and the facility operations have ceased. The two residents in care relocated to Wesley House 11.

Janet Leon Administrator/Licensee surrendered the facility License. The effective closure date of the facility is November 1, 2021.

LPA reviewed this report with Janet Leon and provided a copy of the report.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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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