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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202490
Report Date: 01/18/2024
Date Signed: 01/18/2024 05:09:00 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/18/2024 05:09 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:PEARSON FAMILY HOMEFACILITY NUMBER:
435202490
ADMINISTRATOR:MAIMON, APRILFACILITY TYPE:
735
ADDRESS:4924 NEW WORLD DRIVETELEPHONE:
(408) 440-8949
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 6CENSUS: 0DATE:
01/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Eric NamekTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Eric Namek (EN), property manager of the owner (Julianne Ragonesi, JR) of the house..

EN stated the lease with facility licensee was ended on 1/15/2024. The facility is not operating after 1/15/2024.

LPA toured the facility with EN including living room, family room, dining room, garage, 4 bedrooms, 2 bathrooms and backyard.

LPA did not see any residents. The house is in non operational status.

EN stated the house will be remodeled, and rent out later.

LPA talked to the facility licensee on the phone, and the facility license stated he/she will send a formal letter to CCL office to close the facility.

Exit interview was conducted with EN. A copy of the report was provide to EN.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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