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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202099
Report Date: 12/14/2022
Date Signed: 12/14/2022 11:52:56 AM

Document Has Been Signed on 12/14/2022 11:52 AM - 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:WHEELOCK RESIDENTIAL CAREFACILITY NUMBER:
445202099
ADMINISTRATOR:MARIE K. ALCALAFACILITY TYPE:
735
ADDRESS:102 WHEELOCK ROADTELEPHONE:
(831) 768-0941
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 16CENSUS: 15DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jose HernandezTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Jose Hernandez.

During visit, LPA Marrufo toured the facility. LPA Marrufo observed a 30-day supply of PPEs, perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days. LPA Marrufo observed the facility bathroom had available soap, paper towels, and hand washing signs. The outdoor area exits were clear of obstructions.

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

This report was reviewed with Jose Hernandez and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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