Senior Care Records.

Facility Evaluation Report

Twelveacres-braeburn Home, San Jose06/14/2024Licence 435200831

Capacity6
Census4
Date signed06/14/2024 03:31:50 PM
The inspector’s account

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Amy Hellyer.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the kitchen area. LPA Marrufo observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. There were locked drawers for sharps and cleaning supplies. The first aid kit was reviewed and found to be complete.

LPA Marrufo tested the smoke detectors in the hallway and four out of four bedrooms. Each smoke detector functioned properly when tested. The resident bedrooms had functioning lights and available bedding and clothing storage areas.

LPA toured three out of three resident bathrooms and observed the water temperatures to be between 114 F and 118 F. Each bathroom had functioning lights and available soap and paper towels.

The outside area was toured and the outside exit was observed to be clear of obstructions.

LPA reviewed the Personal and Incidental Money Logs for 4 out of 4 residents and found them to be balanced. LPA Marrufo reviewed 4 out of 4 resident records and 5 staff records and found them to be complete.

The Earthquake and Fire Drill Log indicates the last recorded drill was conducted on 06/06/2024.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Amy Hellyer and a copy of this report was provided.

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