Senior Care Records.

Facility Evaluation Report

Evergreen Guest Home #2, San Jose06/25/2025Licence 430707505

Capacity6
Census6
Date signed06/25/2025 04:46:10 PM
Name of licensing program analystManuel Monter
Name of licensing program managerRomeo Manzano
The inspector’s account

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver the results of a complaint investigation. During the complaint investigation for the complaint 26-AS-20240312154828, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Lead Staff Robert Foranda

During the tour of the facility, LPA attempted to turn on the ceiling fan for light for bedroom 1. LPA activated the light switch but the ceiling fan's fan did not activate nor did the lights. Staff S1 stated the ceiling fan is not working. S1 stated the ceiling fan has not been working for 2 months.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Lead Staff Robert Foranda. A copy of the report was provided. Appeal rights were provided.

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