Senior Care Records.

Facility Evaluation Report

Evergreen Guest Home #2, San Jose09/19/2025Licence 430707505

Capacity6
Census6
Date signed09/19/2025 04:04:38 PM
Name of licensing program analystManuel Monter
Name of licensing program managerRomeo Manzano
The inspector’s account

On September 19, 2025 San Bruno Regional Office - San Jose Unit conducted a non-compliance conference meeting with Licensee Evelyn Canonizado and Licensee Florencio Canonizado. Present in the meeting were Licensing Program Manager Romeo Manzano (covering for Regional Manager Jackie Jin), Licensing Program Analyst Manuel Monter, Licensing Program Analyst Marcela Yanez.

During the non-compliance meeting, the following serious violations were discussed: 80092.2 Restricted Health Condition Care Plan, 85068.3 Modifications to Needs and Services Plan, 80064 Administrator Qualifications and duties, 80078 Responsibility for Providing Care and Supervision, 80065 Personnel Requirements

During todays NCC meeting, the Department discussed with Licensees regarding the elopement of a resident that occurred on July 13, 2025 and Type A deficiencies that have been cited in the past 5 years was discussed.

This report was reviewed with Licensee Evelyn Canonizado and Licensee Florencio Canonizado and a copy of the report and LIC9111 was provided.

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