<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200696
Report Date: 02/28/2022
Date Signed: 02/28/2022 03:25:29 PM

Document Has Been Signed on 02/28/2022 03:25 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:MARIAN HALLFACILITY NUMBER:
435200696
ADMINISTRATOR:ADORAIM VILLANUEVAFACILITY TYPE:
735
ADDRESS:443 SOUTH 11TH STREETTELEPHONE:
(408) 279-9892
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 34CENSUS: 31DATE:
02/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Margie VillanuevaTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Margie Villanueva.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the visitor screening area and observed the facility PPE supply, which included a 30-day supply of PPEs. LPA Marrufo toured the kitchen area and observed the facility had a perishable food supply of at least 3 days and a non-perishable food supply of at least 7 days.

LPA Marrufo toured the facility hallways, outside area, and exits. LPA Marrufo toured 9 out of 18 resident bedrooms. During tour, LPA Marrufo observed the bed sheets and mattresses in the 9 toured rooms and did not observe any bed bugs. LPA Marrufo interviewed 10 out of 31 residents, and all interviewed residents stated that they had not observed bed bugs at the facility within the last 3 months. Administrator Margie Villanueva stated that a pest control contractor sprays the facility for bed bugs whenever there are bed bugs observed at the facility. Administrator Margie Villanueva stated the last time the pest control contractor came to the facility was 02/24/2022. She stated she does not have invoices to document the contract. LPA Marrufo advised Administrator Margie Villanueva to maintain invoices and documentation of the contracted visits done by the pest control contractor.

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

This report was reviewed with Administrator Margie Villanueva and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1