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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202518
Report Date: 02/27/2024
Date Signed: 02/27/2024 05:34:25 PM

Document Has Been Signed on 02/27/2024 05:34 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:ALEXANDRIA VICTORIAFACILITY NUMBER:
445202518
ADMINISTRATOR:JOHN GRYSPOS, JR.FACILITY TYPE:
740
ADDRESS:226 MORRISSEY BOULEVARDTELEPHONE:
(831) 429-9137
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 13CENSUS: 9DATE:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Ophelia GrysposTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Ophelia Gryspos.

During visit, LPA Marrufo toured the facility inside and out.

Due to time constraints, the facility inspection visit will need to be continued at a later time.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Ophelia Gryspos and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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