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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440708909
Report Date: 02/14/2025
Date Signed: 03/03/2025 02:27:44 PM

Document Has Been Signed on 03/03/2025 02:27 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:WESLEY HOUSE IIIFACILITY NUMBER:
440708909
ADMINISTRATOR/
DIRECTOR:		LEON, JANETFACILITY TYPE:
740
ADDRESS:123 LA SELVA DRIVETELEPHONE:
(831) 685-0646
CITY:LA SELVA BEACHSTATE: CAZIP CODE:
95076
CAPACITY: 6CENSUS: 6DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Janet LeonTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Janet Leon.

During visit, LPA toured the kitchen and food storage areas. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and observed it to be complete.

LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The bathroom sinks had water temperatures at 109 F and 111 F. LPA toured five out of five resident bedrooms. Each bedroom had available bedding and clothing storage areas. Each bedroom had working lights. LPA tested the smoke and carbon monoxide detectors in the facility and the detectors functioned properly when tested.

LPA reviewed six out of six resident records, including Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed five staff records and found them to be complete.

LPA reviewed the Emergency Disaster Drill Log, which indicated that the last emergency disaster drill was conducted on 11/05/2024.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Janet Leon and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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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