Senior Care Records.

Facility Evaluation Report

Norseman Adult Residential Facility INC, San Jose10/29/2024Licence 435202776

Capacity4
Census4
Date signed10/29/2024 02:59:13 PM
The inspector’s account

Licensing Program Analyst (LPAs) Marcela Yanez and Manuel Monter conducted an unannounced Required 1 Year visit and met with Cecilia Valenzuela, Administrator/Licensee.

During visit, LPAs toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days.

LPAs toured 4 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA tested the smoke detectors in the hallway to function properly when tested. LPAs toured resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperature in the bathroom measured with thermometer at 118.0 degrees F.

LPAs toured the outside area and found the exits to be clear of obstructions. LPAs observed fire extinguisher was last serviced on 10/17/2024. LPA reviewed Fire and Earthquake log was last conducted on 10/04/2024

LPAs reviewed resident records for 3 residents, Centrally Stored Medication Log, and P&/I. LPAs reviewed 4 staff records.

No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Cecilia Valenzuela and a copy of this report was provided.

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