Senior Care Records.

Facility Evaluation Report

Koen ARF, San Jose04/09/2025Licence 435202793

Capacity6
Census6
Date signed04/09/2025 04:35:15 PM
Name of licensing program analystManuel Monter
Name of licensing program managerRomeo Manzano
The inspector’s account

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management- Deficiencies visit. LPA met with Lead Staff Victoria Agnes. LPA explained the purpose of the visit. During the visit, LPA observed 5 residents and 2 staff.

The purpose of the visit is a follow up visit regarding the change of ambulatory status in bedrooms 1 & 3.

On April 3, 2025, The Department received the approved fire clearance, stating bedroom #1 and bedroom #3 can have 2 non ambulatory residents each.

On April 9, 2025, LPA Monter toured the facility inside and out. LPA observed the garage partition has been removed and the garage is being used as a storage space/ laundry room.

No deficiencies cited during today's visit. This report was reviewed with Lead Staff Victoria Agnes and a copy of the signed report was provided.

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