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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445200582
Report Date: 06/21/2024
Date Signed: 06/21/2024 03:44:23 PM

Document Has Been Signed on 06/21/2024 03:44 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:WRC-1FACILITY NUMBER:
445200582
ADMINISTRATOR/
DIRECTOR:
MEGAN C. MILLERFACILITY TYPE:
735
ADDRESS:155 WILLOWBROOK DRIVETELEPHONE:
(831) 336-5196
CITY:BEN LOMONDSTATE: CAZIP CODE:
95005
CAPACITY: 34CENSUS: 32DATE:
06/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Elvira RodriguezTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Elvira Rodriguez, Administrator.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the kitchen area 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. The first aid kit was reviewed and found to be complete.

LPA Marrufo toured three out of three hallway bathrooms and observed the water temperatures to be 105 F - 108 F. Each bathroom had available soap and paper towels and working lights. LPA toured 8 out of 29 resident bedrooms and found each bedroom to have available bedding and clothing storage areas. Each bedroom had working lights.

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

LPA reviewed 5 resident Centrally Stored Medication Records and 5 resident records and found them to be complete. LPA reviewed 5 staff records and found them to be complete.

LPA reviewed the Emergency Disaster Drill Log and observed the last recorded drill was conducted on 05/15/2024.

LPA requests that a copy of the last Smoke Detector Inspection Report be submitted to CCL by 06/26/2024.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Elvira Rodriguez and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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