Senior Care Records.

Facility Evaluation Report

Evergreen Adult Development Center, San Jose10/24/2023Licence 435201385

Capacity216
Census80
Date signed10/24/2023 10:50:00 AM
The inspector’s account

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Caroline C Mayo . ADM informed LPA that the facility has 40 staff and approximately 80 clients.

LPA toured the facility inside out with ADM which included; the classrooms, kitchen, conference rooms, office areas, and restrooms. The staff area of the facility was also inspected. Front yard and backyard of the facility was also inspected. There was no obstruction to block the walkways. LPA observed various clients doing activities during visit. Some of the activities included dancing, drawing, working on puzzles. LPA also observed some resident preparing to leave for an outing as well.

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 clients in care. Room temperature was at 75 degree F, and hot water temperature was measured to range from 108-110 degrees F in 4 client bathrooms.

The facility was equipped with smoke & carbon monoxide detectors, Fire extinguishers and they were last serviced on July 10, 2023. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on October 18, 2023.

LPA reviewed facility records for 3 staff and 3 clients. LPA reviewed 3 clients medications and centrally stored medication records.

No deficiencies cited during today's visit. This report was reviewed with Administrator Caroline C Mayo and a copy of the signed report was provided.

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