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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202625
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:06:05 PM

Document Has Been Signed on 02/18/2025 04:06 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/
DIRECTOR:
GRYSPOS JR, JOHNFACILITY TYPE:
740
ADDRESS:228 MORRISSEY BLVDTELEPHONE:
(831) 429-9137
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Administrator, John Gryspos, JrTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced at 3:05PM to conduct the facility's Required 1-Year annual inspection. LPA met with Administrator John Gryspos, Jr. ADM states the facility has 6 residents. LPA toured the facility's interior and exterior with the ADM, to include the dining room, kitchen, living room, resident bedrooms, and the front and back of facility. All exits and passageways were free and clear of obstruction.

LPA toured the kitchen area, and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the digital thermostat on the refrigerator exterior door, refrigerator temperature at 35 degrees F and freezer at 0 degrees F. LPA observed knives and chemicals were locked in separate kitchen cabinets and inaccessible to residents in care. LPA observed a locked medication cart in the dining area, inaccessible to residents in care.

LPA toured 6 resident bedrooms. 6 out of 6 resident bedrooms had a bed, clean bedding, a lamp, space for personal belongings, and a chair.

Due to time constraints, this annual inspection will need to be continued at a later date.

No deficiencies were issued during today's visit. An exit interview was conducted with Administrator, John Gryspos, Jr and a copy of this report was provided.
Jin JackieTELEPHONE: (714) 319-3786
Marcella TarinTELEPHONE: (714) 328-5152
DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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