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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445200907
Report Date: 02/20/2024
Date Signed: 02/20/2024 04:21:31 PM

Document Has Been Signed on 02/20/2024 04:21 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 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:
02/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Nereida TiscaraTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Nereida Tiscara.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the kitchen and food storage areas and observed a perishable food supply of at least two days and a non-perishable food supply of at least 7 days. LPA Marrufo toured 2 out of 2 resident bathrooms and observed the water temperature to be 110 F and 111 F. LPA Marrufo toured 4 out of 4 resident bedrooms and observed each bedroom to have functioning lights and available bedding and clothing storage areas.

The smoke detectors in each bedroom and hallway and carbon monoxide detector were tested and found to function properly when tested. The outdoor areas were toured and the outdoor exit was free of obstructions.

LPA Marrufo reviewed resident and staff records and found them to be complete. The Disaster Drill Log recorded the last disaster drill was conducted on 02/03/2024.

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

This report was reviewed with Nereida Tiscara and a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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