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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445201931
Report Date: 07/12/2024
Date Signed: 07/12/2024 04:18:04 PM


Document Has Been Signed on 07/12/2024 04:18 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:RILLERA'S GUEST HOME 2FACILITY NUMBER:
445201931
ADMINISTRATOR:RILLERA, ZOSIMAFACILITY TYPE:
740
ADDRESS:115 GERA COURTTELEPHONE:
(831) 768-1965
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:6CENSUS: 6DATE:
07/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Zosima RilleraTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Zosima Rillera, Administrator.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the kitchen area and food storage areas in the garage. The facility had a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed locked storage areas for sharp objects and cleaning supplies. LPA observed the first aid kit and found it to be complete.

LPA toured 4 out of 4 resident bedrooms and observed each bedroom to have available bedding and clothing storage areas and working lights. LPA Marrufo tested the smoke detector system and found it to be functional when tested. LPA toured the outside area and found the exits to be clear of obstructions.

Due to time constraints, the annual inspection will need to be completed at a later time.

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

This report was reviewed with Administrator Zosima Rillera and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
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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