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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707894
Report Date: 03/11/2025
Date Signed: 03/11/2025 10:57:06 AM

Document Has Been Signed on 03/11/2025 10:57 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/
DIRECTOR:
MARIA SOLISFACILITY TYPE:
775
ADDRESS:588 NORTH FOURTH STREETTELEPHONE:
(408) 294-2505
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 30CENSUS: 20DATE:
03/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Maria SolisTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Maria Solis.

During visit, LPA Marrufo toured the facility inside and out. LPA toured the activity area and observed crafts for residents. LPA toured the kitchen and observed locked drawers for cleaning supplies. LPA toured the storage area and observed locked drawers for chemicals. LPA reviewed the facility first aid kit and found it to be complete.

LPA toured the resident restrooms and observed the bathrooms to have available soap and paper towels and working lights. The water temperatures in the bathrooms measured between 107 F to 108 F.

LPA toured the outside area and found the exits to be clear of obstructions.

LPA reviewed six resident records and found them to be complete. The facility does not store medications for residents and does not hold personal belongings or money for the residents. LPA reviewed six staff records and found them to be complete.

The emergency disaster drill log indicates that the last drill was conducted on 10/17/2024. During visit, facility staff tested the smoke detector system and LPA observed that it functioned properly. Staff tested the carbon monoxide detector in the activities area and LPA Marrufo observed that it functioned properly when tested.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Maria Solis and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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