Senior Care Records.

Facility Evaluation Report

Angie's Haven Home, San Jose04/22/2025Licence 435200679

Capacity6
Census6
Date signed04/22/2025 04:45:56 PM
Name of licensing program analystDavid Marrufo
Name of licensing program managerSarah Yip
The inspector’s account

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Administrator Paul Aliason.

During visit, LPA toured the facility inside and out. LPA toured the kitchen area and 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 observed the kitchen to have locked drawers for sharp objects and cleaning supplies. LPA observed the facility first aid kit and found it to be complete.

LPA toured four out of four resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA tested the smoke detectors in the hallway and in all four resident rooms and found them to function properly when tested. The carbon monoxide detector functioned properly when tested. LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks were between 105 F and 106 F. LPA toured the outside area and found the outdoor exit to be clear of obstructions.

LPA reviewed the Personal and Incidental Money Logs for six out of six residents and found them to be complete. LPA reviewed three out of three Centrally Stored Medication and Destruction Records (only three residents take medications) and found them to be complete. LPA reviewed six out of six resident records and four staff records and found them to be complete. The Emergency Disaster Drill Log indicates the last recorded drill occurred on 02/07/2025. No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Paul Aliason and a copy of this report was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction