Senior Care Records.

Facility Evaluation Report

Evergreen Guest Home #2, San Jose07/15/2025Licence 430707505

Capacity6
Census6
Date signed07/15/2025 08:22:29 AM
Name of licensing program analystManuel Monter
Name of licensing program managerRomeo Manzano
The inspector’s account

Licensing Program Analyst Manuel Monter conducted an unannounced case management visit-incident regarding an incident report, which stated a resident had eloped from the facility. LPA explained the purpose of the visit.

On July 14, 2025 the Department received an incident report regarding a resident (referred as R1) who eloped from the facility. According to the report, on July 13, 2025, at around 3:30pm, R1 yelled and walked out the house “going so fast.” Staff followed AR1, but he/she was so fast and staff lost sight of R1. Staff continued to look for R1 but couldn’t see him/her anymore. Staff came back and reported he/she lost track of R1. At around 5:09pm, ADM reported to police R1 as missing. Around 5:33pm staff went out for a walk and found R1 sitting under street along McLaughlin ave, and was brought back to the facility.

On July 15, 2025, LPA Manuel Monter received copies of R1's files.

LPA determined this event requires further investigation.

This report was reviewed with Lead Staff Robert Foronda and a copy of the report was provided.

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