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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202625
Report Date: 02/08/2023
Date Signed: 02/09/2023 04:58:06 PM


Document Has Been Signed on 02/09/2023 04:58 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:ALEXANDRIA VICTORIA 2FACILITY NUMBER:
445202625
ADMINISTRATOR:GRYSPOS JR, JOHNFACILITY TYPE:
740
ADDRESS:228 MORRISSEY BLVDTELEPHONE:
(831) 429-9137
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:8CENSUS: 6DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:John Gryspos Jr.TIME COMPLETED:
03:47 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection of the facility. LPA met with facility Administrator John Gryspos Jr (Admin).

LPA began touring the facility inside and out including living room, kitchen, dining room, all bathrooms and bedrooms, storage rooms, med room. All staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated.

Facility Infectious Control plan has already been submitted. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. All restrooms were stocked with paper towels. Hand washing signs observed in all bathrooms. Social distancing signs observed to be posted in all public areas.

Facility observed to have designated entry point via Alexandria Victoria 1, which is on the same property as Alexandria Victoria 2. Admin indicated that all visitors enter AV2 through AV1 Staff took LPA's temperature, screened for symptoms, and recorded information in visitor log. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. 30 day supply of PPE observed. Fire Extinguishers observed to have been purchased in February 2023. Carbon monoxide/smoke detectors were observed throughout the facility. Facility water temperature observed to be 114.6*F.

No deficiencies cited during today's visit. This report was reviewed with Administrator John Gryspos Jr. and a copy of the signed report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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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