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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445200907
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:14:35 PM

Document Has Been Signed on 02/16/2023 03:14 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 HILLS RANCHFACILITY NUMBER:
445200907
ADMINISTRATOR:SANCHEZ, DEBI & BILLFACILITY TYPE:
735
ADDRESS:133 BROWNS VALLEY ROADTELEPHONE:
(831) 768-1698
CITY:CORRALITOSSTATE: CAZIP CODE:
95076
CAPACITY: 6CENSUS: 6DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Nereida TiscarenoTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Nereida Tiscareno.

During visit, LPA Marrufo toured the inside and outside of the facility. A visitor screening area was observed at the facility entrance. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days were observed. LPA Marrufo observed cleaning supplies stored in a locked storage area. A 30-day supply of PPEs were observed. Two out of two resident bathroom had available soap, paper towels, and hand washing signs. The outdoor exit was clear of obstructions.

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

This report was reviewed with Nereida Tiscareno and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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