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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200712
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:11:13 PM

Document Has Been Signed on 09/27/2022 03:11 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:CAMARGO HOMEFACILITY NUMBER:
435200712
ADMINISTRATOR:NAPOLEON FRANCISCOFACILITY TYPE:
735
ADDRESS:1911 CAMARGO DR.TELEPHONE:
(408) 941-0712
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 6CENSUS: DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Napoleon FranciscoTIME COMPLETED:
03:14 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 09/27/2022. LPA met with facility Administrator Napoleon Francisco (Admin).

LPA toured the facility, including front hall, living room, garage, 2 bathrooms, 4 bedrooms, kitchen, dining room, and back yard. Staff members were observed not to be wearing masks upon LPA arrival, staff had masks immediately accessible that were donned upon LPA request. Admin confirmed that all staff and residents have been vaccinated.

No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. 30 days worth of PPE was observed.

Facility observed to have designated entry point, but staff did not take LPA's temperature, nor screen for symptoms. Hand washing signs observed in all bathrooms. Social distancing signs observed to be posted in all public areas.

Facility fire extinguishers were observed to have gauges within acceptable levels. Facility water temperature observed to be 107.4*F. Residents were observed eating in the dining room. LPA observed smoke detectors and a carbon monoxide detector, which were tested and observed to be operational.

No deficiencies cited during today's visit. Advisory notes issued This report was reviewed with Administrator Napoleon Francisco and a copy of the signed report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Ryker Heberle
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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