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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445200724
Report Date: 05/29/2024
Date Signed: 05/29/2024 12:21:15 PM

Document Has Been Signed on 05/29/2024 12:21 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:APTOS COUNTRY HOMEFACILITY NUMBER:
445200724
ADMINISTRATOR/
DIRECTOR:
SANCHEZ, BILL & DEBIFACILITY TYPE:
735
ADDRESS:8# MOUNTAIN VIEWTELEPHONE:
(831) 724-0150
CITY:CORRALITOSSTATE: CAZIP CODE:
95076
CAPACITY: 6CENSUS: 5DATE:
05/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Bill and Debi SanchezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Bill and Debi Sanchez.

During visit, LPA Marrufo toured the facility inside and out. The facility kitchen area had a perishable food supply of at least two days and a non-perishable food supply of at least 7 days. There was a locked drawer for cleaning supplies. LPA Marrufo reviewed the first aid kit and found it to be complete.

LPA Marrufo toured the facility bathroom. The water temperature in the sink was 119 F. The bathroom had working lights and available soap and paper towels. LPA Marrufo toured 3 out of 3 resident bedrooms. Each bedroom had functioning lights and available bedding. The smoke detectors in the bedrooms and hallways worked properly when tested. The carbon monoxide detector functioned properly when tested.

LPA Marrufo toured the outside area. The pool gate was locked and the outside exit was clear of obstructions.

LPA reviewed the Centrally Stored Medication Log and the Personal and Incidental Money Log. Both logs were complete and balanced. LPA Marrufo observed the Emergency Disaster Drill Log and found the last recorded drill was on 04/1/2024.

LPA Marrufo reviewed resident and staff records and found them to be complete.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Bill and Debi Sanchez and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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