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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707894
Report Date: 03/27/2024
Date Signed: 03/27/2024 04:30:30 PM

Document Has Been Signed on 03/27/2024 04:30 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
CCLD Regional Office, 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: 12DATE:
03/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:Maria SolisTIME COMPLETED:
04:23 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit and met with Social Services Administrator (SSA) Maria Solis.

8 clients and 15 staff were observed in the facility.

LPA toured the facility inside with SSA. The facility has 3 stories. The facility currently has contractors conducting painting the whole outside building. The first floor has activity rooms, offices, two restrooms and storage rooms. The second floor has dinning room, kitchen, game room, multiple purpose room, offices and two restrooms. The third floor has activity room, offices, conference room, and library. Room temperature was at 68 degree F, and hot water temperature was at 116 degree F.

First aid box and flash lights were observed in the facility.

Fire extinguishers last serviced on 12/11/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors were tested by staff. The smoke detectors were working fine.

LPA reviewed 5 resident files and 5 staff files.

The last time the facility conducted the emergency and fire drill is 10/19/2023.

After LPA toured the facility, and finished reviewing the client files and staff files, all the client and staff except SSA left the facility already.

No citation noted today. Exit interview was conducted with SSA. The report was provided to SSA for signature. A copy of the report was provided to SSA.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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