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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202902
Report Date: 11/17/2023
Date Signed: 11/17/2023 11:24:03 AM

Document Has Been Signed on 11/17/2023 11:24 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:MOBILE WORK GROUPFACILITY NUMBER:
445202902
ADMINISTRATOR:MORRIS, MAUNAFACILITY TYPE:
775
ADDRESS:1062 SOUTH GREEN VALLEY RDTELEPHONE:
(831) 728-0321
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 28CENSUS: 0DATE:
11/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mauna MorrisTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) David Marrufo conducted a Pre-Licensing visit and met with Mauna Morris.

During visit, LPA Marrufo toured the facility area, bathroom, and staff break room. The facility bathroom had available soap, hand drying machine, and water temperature of 110 F. LPA observed that there were no clients present at the facility during visit.

During visit, LPA Marrufo observed that there were place holders indicating where tables will be placed. LPA Marrufo observed the fire extinguisher was last inspected on 11/15/2022 and there was no carbon monoxide detector in the facility area.

LPA Marrufo requests that Administrator Mauna Morris submit photographs of tables and chairs as well as photographs of Resident Right's Posters posted on facility walls, of an updated fire extinguisher inspection tag, and of an installed carbon monoxide detector by 12/15/2023.


LPA Marrufo reviewed Component III Presentation with Administrator Mauna Morris.

Advisory Notes were issued. See LIC9102 for more information.


No deficiencies were cited at this time as per California Code of Regulations, Title 22. This report was reviewed with Administrator Mauna Morris and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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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