Senior Care Records.

Facility Evaluation Report

Evergreen Home, San Jose01/09/2025Licence 435202812

Capacity6
Census6
Date signed01/09/2025 03:45:42 PM
The inspector’s account

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management-incident regarding an incident which occurred where Resident (R1) eloped from the facility. LPA Monter met with Administrator Thuy Tran and stated the purpose of today's visit.

On December 30, 2024, the Department received an incident report (IR) stating the following, “ On December 27, 2024 around 2pm, staff was working with another resident regarding his/her P&I in the kitchen while R1 was in the living room watching television in the sofa. After the other resident left, he/she left the front door open. While staff was in the kitchen balancing P&I, R1 left the home without staff’s knowledge. This staff and R1 were the only individual’s home at this time. When staff noticed that R1 was not in the home, he/she ran down the block to search for R1 and informed Administrator and other staff nearby to help search for R1. Within 5 minutes of the search, R1 was found with SJPD, one block from the home. R1 was returned to the home without further incident. … Staff have also been instructed to provide constant supervision to avoid another unauthorized absence. “

On December 27, 2024, at about 2:11pm Local Law Enforcement (LLE) responded to a report of resident with developmental disabilities, trying to run into a busy street. LLE arrived at the scene at 2:15pm

On January 9, 2025, LPA Manuel Monter attempted to interviewed R1. Resident R1 did not answer LPA's questions. R1 was asking for a snack and walked away from LPA

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