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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
430708817
Report Date:
12/22/2023
Date Signed:
12/22/2023 03:43:29 PM
Document Has Been Signed on
12/22/2023 03:43 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:
TERRACES OF LOS GATOS, THE
FACILITY NUMBER:
430708817
ADMINISTRATOR:
GREGORY BEARCE
FACILITY TYPE:
741
ADDRESS:
800 BLOSSOM HILL ROAD
TELEPHONE:
(408) 356-1006
CITY:
LOS GATOS
STATE:
CA
ZIP CODE:
95032
CAPACITY:
458
CENSUS:
326
DATE:
12/22/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:30 PM
MET WITH:
Bill Penrod
TIME COMPLETED:
04:00 PM
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On 12/22/2023 at 3:30 p.m. Licensing Program Analysts (LPAs) Steve Chang and Maria (Mita) Partoza conducted an unannounced Case Management visit and met with Health Services Administrator (HSA) Bill Penrod and explained that the purpose of the visit was to hand deliver a letter of exclusion for 2 individuals private care giver 1 (PC 1) and private care giver 2 (PC 2) from the facility.
No deficiencies were cited at this time as per California Code of Regulations Title 22.
This report was reviewed with Health Services Administrator Bill Penrod and a copy of the report was provided.
SUPERVISOR'S NAME:
Romeo Manzano
TELEPHONE:
(650) 388-2297
LICENSING EVALUATOR NAME:
Maria Partoza
TELEPHONE:
(669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE:
12/22/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/22/2023
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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