Senior Care Records.

Facility Evaluation Report

Loupe Adult Residential Facility INC., San Jose08/25/2021Licence 435202826

Capacity4
Census0
Date signed08/25/2021 12:07:06 PM
The inspector’s account

At approximately 10:00 AM, Licensing Program Analyst (LPA) Steve Nguyen, conducted a Pre-Licensing Inspection at facility. LPA met with Licensee Jalano and Alyssa Valenzuela; explained the purpose of the visit, and conducted an inspection of facility inside and out.

Facility’s exits were observed to be free of hazards and obstructions. The facility has an Emergency Disaster Preparedness Plan in place, including Covid 19 preparedness. Smoke and carbon monoxide detectors are in working conditions. All toxins, cleaning supplies and hazardous materials were locked in both cabinet and closet space. Water temperature in garage was checked and it was at 110 degrees. Sharp utensils were observed locked in kitchen cabinet. Fire extinguishers located in front hall way, garage, and in back yard; all extinguishers were checked on 8/21/2021 by fire marshal. Observed that facility has 3 days of perishable and 14 days Non-perishable foods on site.

Medications secured in a cabinet. First Aid kit was stocked with supplies to include but not limited to: scissors, tweezers, thermometer, and first aid manual.

At approximately 12:00 PM, review of Component III was completed.

The physical plant is approved for Licensure pending the final approval by Centralized Application Bureau (CAB). No deficiencies were cited per the California Code of Regulation Title 22.

LPA review report summary with Licensee Jalano and Alyssa Valenzuela and a copy was provided.

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