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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707894
Report Date: 09/14/2022
Date Signed: 09/14/2022 11:02:25 AM

Document Has Been Signed on 09/14/2022 11:02 AM - 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:YU-AI KAI SENIOR DAY SERVICESFACILITY NUMBER:
430707894
ADMINISTRATOR:OGAWA, MUTSUKOFACILITY TYPE:
775
ADDRESS:588 NORTH FOURTH STREETTELEPHONE:
(408) 294-2505
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 30CENSUS: 15DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria SolisTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year Visit and met with Maria Solis.

LPA Marrufo observed the facility entrance had a visitor screening area. The hallway bathrooms had available soap, paper towels, and hand washing signs. The facility has a PPE supply of at least 30 days.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

An advisory note was issued. See LIC9102 for more information.

This report was reviewed with Maria Solis and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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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