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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
435202893
Report Date:
07/12/2023
Date Signed:
07/12/2023 03:04:08 PM
Document Has Been Signed on
07/12/2023 03:04 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:
FAMILY FEELS RESIDENTIAL CARE 2
FACILITY NUMBER:
435202893
ADMINISTRATOR:
SHIH, YIWEN
FACILITY TYPE:
740
ADDRESS:
777 TERRAZZO DRIVE
TELEPHONE:
(408) 972-0125
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95123
CAPACITY:
6
CENSUS:
5
DATE:
07/12/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Rita Garcia
TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Rita Garcia.
The purpose of the visit was to amend a report from 06/02/2023.
No deficiencies were cited at this time as per California Code of Regulations Title 22.
This report was reviewed with Rita Garcia and a copy of the report was provided.
SUPERVISORS NAME
:
Sarah Yip
LICENSING EVALUATOR NAME
:
David Marrufo
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/12/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/12/2023
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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