Senior Care Records.

Facility Evaluation Report

CCC ARF INC. DBA Nantucket Home 3, San Jose01/15/2025Licence 435201943

Capacity6
Census3
Date signed01/15/2025 03:58:34 PM
The inspector’s account

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Maria Valentina Cristobal, Administrator. LPA announced the purpose of the visit. LPA observed 3 staff and 1 resident and 2 of 3 resident at day program.

During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days, Refrigerator temperature was measured at 39 degrees F and freezer was measured at 0 degrees F, and room temperature was 71 degrees F.

LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detectors in the living room and found the smoke detector to function properly when tested. LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer between 112 to 119 degrees F.

LPA toured the outside area and found the exits to be clear of obstructions. LPA observed 2 locked sheds in backyard and are being used as storage and not being used as living quarters. LPA observed fire extinguisher was last serviced on 04/25/24. Facility has a pull fire alarm and was last serviced on 04/08/24. LPA reviewed Fire and Earthquake log last drill for earthquake was conducted on 11/05/24 and fire drill on 11/03/24.

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