Senior Care Records.

Facility Evaluation Report

Cherry Blossom ARF, LLC, San Jose12/04/2024Licence 435202460

Capacity6
Census6
Date signed12/04/2024 12:14:56 PM
The inspector’s account

On December 04, 2024, at 10:50 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Administrator, Marylou Williams and disclosed the purpose of the inspection. The administrator informed the LPA that the facility currently has 6 residents in care, 4f level, and all 6 are ambulatory. Residents were away at their day program.

At 10:55 AM, the LPA initiated a walk-through of the facility, accompanied by the administrator.

At 10:51 AM, the LPA inspected the kitchen and found it clean, with no food preparation or cooking in progress at the time. LPA checked the appliances and observed them in working order. The locked cabinet containing knives and the locked cabinet under the sink with soap and cleaning supplies were also inspected. LPA inspected the refrigerator and pantry cabinets and observed enough supplies of fresh perishable food for (2) days and nonperishable staples for (7) days. No expired food and no stored medications were noticed.

At 10:58 AM, LPA inspected the dining area next to the kitchen and found it clean. There were 2 bar stools, a dining table, and dining chairs to accommodate all the residents.

At 11:03 AM, LPA inspected the living room, and observed it clean, with all the furniture in good repair. There was a set of couches, chairs, ottoman, desk, and computer station in the living room.

At 11:07 AM, the LPA inspected the fire extinguisher mounted on the wall next to entrance door and found it was fully charged with a last service tag of 01/29/2024. The administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit.

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