Senior Care Records.

Facility Evaluation Report

Mount Blue Residential Care Home INC, San Jose08/18/2025Licence 435202656

Capacity6
Census6
Date signed08/18/2025 05:58:38 PM
Name of licensing program analystSimranjit Rai
Name of licensing program managerRomeo Manzano
The inspector’s account

Licensing Program Analyst Simi Rai arrived at the facility unannounced to conduct a case management – other visit. LPAs met with Staff, Edelyn Guevara and Licensee/Administrator Fredricka Safar was informed via phone call. LPA observed 3 staff members and 6 residents at the facility.

The purpose of the visit is to hand deliver an immediate exclusion letter for an individual (S1) who the Department determined engaged in conduct inimical as a staff in the facility.

S1 was not currently working in the facility. The facility's administrator stated the staff was terminated 7/25/2025.

The immediate exclusion letter was handed to the Staff, Edelyn Guevara. Administrator, Fredricka Safar was informed to remove S1 from any contact with residents and not allow S1 to be physically present in the facility. The ADM was advised to separate S1 from the facility roster.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Staff, Edelyn Guevara and a copy of the report was provided.

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