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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200391
Report Date: 06/25/2024
Date Signed: 06/25/2024 12:10:15 PM

Document Has Been Signed on 06/25/2024 12:10 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:EMPLOY AMERICAFACILITY NUMBER:
435200391
ADMINISTRATOR/
DIRECTOR:
MERITA AMITUANAIFACILITY TYPE:
775
ADDRESS:124 BLOSSOM HILL RD, STE. FTELEPHONE:
(408) 574-3950
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 45CENSUS: 18DATE:
06/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Administrator, Merita AmituanaiTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced annual inspection visit, and met with Administrator (ADM) Merita Amituanai and stated the purpose of today's visit. During the visit, LPA observed 18 clients and 6 staff. This facility' clients are Developmentally Disabled and are overseen by San Andreas Regional Center.

LPA toured the reception area, activity room, kitchen, 2 bathrooms, isolation room, storage room, and 5 offices. The facility does not provide meals as clients bring their own meals and snacks from their respective homes. The facility does have extra snacks to provide to the clients attending the day program. All rooms in facility noted to be clean and well maintained. All 3 emergency exits noted to be clear of obstruction.

Chemicals and toxins are locked in the storage room. Fire extinguisher was inspected on 3/4/2024. Smoke alarm and carbon monoxide detectors were inspected by third party vendor on 3/4/2024 and the detectors are in working condition. Emergency first aid kit were observed in the facility. The last disaster drills were conducted on 3/15/2024 and 4/15/2024.

All restrooms stocked with paper towels, soap, and paper supplies were observed to be available. Water temperature in restroom sinks measured ranged from 108.1 degrees F to 108.9 degrees F. Water temperature in kitchen sink measured at 107.7 degrees F.

LPA reviewed facility records for 10 clients and 10 staff and all files were complete.

No deficiencies are being cited during today's visit. This report was reviewed with Administrator (ADM) Merita Amituanai and a copy of the signed report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
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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