Senior Care Records.

Facility Evaluation Report

Evergreen Guest Home #1, San Jose01/25/2023Licence 435202269

Capacity6
Census6
Date signed01/25/2023 04:42:25 PM
The inspector’s account

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Marina Gumarad.

LPA Marrufo toured the facility inside and out. LPA Marrufo observed there to be a visitor screening form. LPA Marrufo observed a 30-day supply of PPEs. LPA Marrufo observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. LPA Marrufo observed there to be available soap and paper towels in the bathroom.

LPA Marrufo toured the outdoor exits and observed them to be free of obstructions.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Marina Gumarad.

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