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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200391
Report Date: 06/17/2026
Date Signed: 06/20/2026 01:52:01 PM

Document Has Been Signed on 06/20/2026 01:52 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: 65DATE:
06/17/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Dulce MorenoTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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On 06/17/2026, at 8:30 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza, arrived at the facility to conduct the annual required 1 year inspection and was met by 3 staff. Program Director (PD) Dulce Moreno arrived at the facility 5 minutes there after.

The facility is licensed as an Adult Day Program for individuals who have intellectual delay disability (IDD) ages of which 15 may be non-ambulatory. The facility is a vocationally oriented Adult Day Program designed to support adults with developmental disabilities in gaining work skills, independence, and community involvement.

LPA toured the facility inside and outside. The room temperature is at 72 degree F. The facility has case manager office, staff room and offices. The facility has an open floor plan, with designated areas, such as the activity area, a media room, kitchen, exercise area and seating area. 2 bathroom, one of the two bathroom is single occupancy, and the second bathroom, has 2 cubicles, one is equipped with a changing area with washer for clients who needs to be assisted with toileting and changing, a Hoyer lift, hygiene supplies, paper supplies and trash bins with lids and grab bars.

The facility has a locker for each client, and cabinets to store activity supplies. The facility kitchen is equipped with refrigerator and microwave. No sharps or chemicals were observed in the kitchen. Snacks and cereals were observed by LPA in the pantry. Clients medications are kept in a locked cabinet and given back to the client at the end of the day. PD stated that the facility staff does not administer the medications to the clients, but the clients administers it themselves. PD stated the facility locks the medication for safety.
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NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 AMERICA
FACILITY NUMBER: 435200391
VISIT DATE: 06/17/2026
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LPA measured the hot water temperature with a digital thermometer and hot water temperature in the kitchen and bathroom ranges from 111 degree F to 114 degree F. The facility is equipped with fire extinguishers that were inspected on 01/29/2026. The facility is equipped with water sprinklers and wall pull alarm system. LPA observed emergency exits are free from tripping hazards and exits are not obstructed.

LPA reviewed 4 clients file and 4 staff file. LPA observed that the LIC 602 (Physician's assessment report) on file of 4 out of 4 clients were from 2007, 2011, 2017 and 2023. LPA reviewed 4 out of 4 staff records. LPA observed 3 out of 4 staff record does not have the Health Screening (LIC 503) required prior to employment per California Code of Regulations (CCR) Title 22, 82065 Personnel Requirement (g) All personnel, including the licensee, administrator, and volunteers, shall be in good health, and shall be physically, mentally, and occupationally capable of performing assigned tasks.(1)The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment...

LPA reviewed 10 out of 10 vehicle record. LPA observed that vehicles have current registration, and insurance on file. The facility, does not maintain a vehicle maintenance log for each vehicles used to transport clients, however, facility files invoices of repairs and maintenance of each vehicle. A technical assistance was provided to facility for 82074 (c) Motor vehicles used to transport clients shall be maintained in a safe operating condition by developing a maintenance log for each vehicle to ensure that repairs are done timely, consistently and tracked accordingly.

LPA reviewed the facility emergency disaster plan (LIC 610D) training record and observed that the facility conducted disaster training on the following dates 12/2/2024, and 10/10/2025. Based on facility file review the facility conducts fire and earthquake drills every months for each shift last drill was conducted on 04/15/2026.

Deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Program Director (PD) Dulce Moreno and a copy of the report was provided.

End of report
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NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/20/2026 01:52 PM - It Cannot Be Edited


Created By: Maria Partoza On 06/17/2026 at 02:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: EMPLOY AMERICA
FACILITY NUMBER: 435200391

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82070(f)
82070 Client Records (f) The information specified in Sections 82070(b)(1)-(13) must be updated as necessary to ensure the accuracy of the client's record. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in 4 out of 4 client's record. Clients 1 to 4 (C1 to C4) current physician's medical report on file was from 2007, 2011, 2017 and 2023, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2026
Plan of Correction
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Program Director (PD) stated that he/she will contact the group homes and request for copies of the most recent LIC602 for 3 of the clients, and 1 Out of 4 Client reside with family PD will request a copy of the updated LIC 602 from the family. PD stated that he/she will submit proof of correction to LPA on or before the POC due date of 07/01/2026
Type B
Section Cited
CCR
82066(a)(10)
82066 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g). This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above 3 out of 4 staff file record. The licensee did not ensure that S1, S2, and S3 has the required health screening (LIC503) in their file as specified in section 82065(g), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2026
Plan of Correction
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Program Director (PD) stated that he/she have staff acquire physical check up and will update their file and get their get TB testing updated on or before the POC due date of 07/01/2026. PD stated that he/she will submit proof of correction on or before the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Maria Partoza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2026


LIC809 (FAS) - (06/04)
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