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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202722
Report Date: 08/30/2022
Date Signed: 08/31/2022 08:38:54 AM


Document Has Been Signed on 08/31/2022 08:38 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:RACHELLE'S HOME IIFACILITY NUMBER:
445202722
ADMINISTRATOR:RECINTO, RACHELLEFACILITY TYPE:
740
ADDRESS:109 BEHLER RDTELEPHONE:
(831) 319-4465
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:12CENSUS: 11DATE:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Arbin BagamaspadTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Arbin Bagamaspad, Office Manager.

During visit, LPA Marrufo toured the inside and outside of the facility. The facility was observed to have a visitor screening area at the entrance. LPA Marrufo observed there to be a PPE supply of at least 30 days, a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days. The outdoor exist was observed to be clear of obstructions.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Arbin Badamaspad and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022
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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