Senior Care Records.

Facility Evaluation Report

Kimberly's Elder Kare Kottage, San Jose07/26/2024Licence 435294206

Capacity6
Census4
Date signed07/26/2024 12:48:47 PM
The inspector’s account

On 7/26/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint visit to deliver findings . LPA met with Administrator Annabelle Esperanza and explained the purpose of today's visit.

During the investigation of complaint control # 26-AS-20220831120143 , LPA Donato found that the facility did not report an incident to Licensing in which a resident was sent to the emergency room due to UTI.

Deficiency of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties.

Report is reviewed with Co-Administrator and a copy is provided with appeal rights.

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