Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Angelita Bernardo. During the visit, LPA observed 2 residents and 1 staff. LPA explained the purpose of the visit.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. LPA observed a storage space area in the backyard being used for storage. There was no obstruction to block the walkways. During the tour of the facility, LPA noted to ADM the clutter throughout the facility. LPA advised to ADM to de-clutter her facility. While touring the backyard, LPA observed a can of butane gas cartridge, directly in front of the storage area, accessible to residents in care. (Photograph was taken.) ADM put locked the can during visit.

During the tour of the facility, LPA observed the facility garage had a partition wall, with 2 bedrooms inside. ADM showed LPA, City of San Jose Department of building plot plan. LPA informed ADM, the Department would follow up on this change, as it is not reflected on the facility sketch.

While touring the resident bedrooms, LPA observed dirt and grime on the walls, window shades, light shade. LPA also observed cobwebs in each of the residents bedrooms, including the hallway bathroom. (Photographs were taken.) While touring the resident bedroom farthest from the front door, had a dresser that was missing one of its shelves. (Photograph was taken.)

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 108 degrees F in both bathrooms. Page 1 Out of 2.