Senior Care Records.

Facility Evaluation Report

Evergreen Guest Home #1, San Jose06/01/2026Licence 435202269

Capacity6
Census4
Date signed06/01/2026 03:54:37 PM
Name of licensing program analystMarcela Yanez
Name of licensing program managerChristine Kabariti
The inspector’s account

On 06/01/2026 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Case Management visit to conduct a Non-Compliance Plan Quarterly Visit and met with Evelyn Canonizado, Administrator (ADM). LPA announced the purpose of the visit. LPA observed 1 resident who is home from day program 3 out of 4 residents at day program. LPA observed 2 staff including Administrator.

The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) after an informal meeting held on 09/15/25.

During visit LPA toured the facility and observed the Gate in the backyard leading to the street was locked with a pad lock. ADM removed the lock and informed staff this should not be on the gate door. ADM tested the carbon monoxide detector. Carbon Monoxide detector functioned properly when tested. During tour LPA observed the facility in good repair and residents rooms had bedding and lighting.

LPA reviewed the facility training that was conducted on 04/28/26 for Documentation of Behavioral Training from 1:30 PM to 2:30 PM, New Consequence Plan training and on 05/07/26 from 1:00 PM to 2:00 PM, Communication training.

LPA interviewed ADM regarding any residents with AWOL or wandering behavior and ADM stated the facility will go with resident and do a visual observation when resident is outside.

Deficiency was cited as per California Code of Regulations Title 22. A civil penalty was assessed for $250 for repeat violation see LIC421FC. This report was reviewed with ADM and a copy of the report and appeal rights were provided.

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