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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707449
Report Date: 02/14/2025
Date Signed: 02/14/2025 01:28:31 PM

Document Has Been Signed on 02/14/2025 01:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:CADAY ADULT RESIDENTIAL FACILITY #2FACILITY NUMBER:
430707449
ADMINISTRATOR/
DIRECTOR:		CADAY, ELLIEFACILITY TYPE:
735
ADDRESS:268 KETCHUM DR.TELEPHONE:
(408) 770-2210
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 6CENSUS: 5DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Ellie CadayTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Ellie Caday. LPA observed 2 staff in the facility. 2 residents went to doctor appointments and 3 residents went to day programs.

LPA reviewed 3 residents files and 3 staff files.

LPA toured the facility inside out with ADM. Licensee, personal rights posters and administrator certificate were observed at the entrance. LPA inspected family room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked. There are 4 rooms for residents, and one staff live-in room in facility. 3 bathrooms are in facility. Room temperature was observed at 73 degree F, and hot water temperature was observed at 119 degree F. 2 days perishable food supplies and 7 days non perishable food supplies were observed sufficient. The temperature of the refrigerator was observed at 4 degree F, and the temperature of the freezer was observed at 0 degree F.

The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm. ADM tested the fire alarm, and carbon monoxide detectors. They were working fine. The fire extinguishers were observed on service on 01/26/2025. First aid box, night lights, flash light were observed in the facility.

LPA inspected the backyard, there was no obstruction to block the walkway. LPA observed one storage rooms at the backyard,

LPA checked the log for fire and emergency drill, the last drill was conducted on 1/27/2025.

No citation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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