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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200712
Report Date: 03/22/2024
Date Signed: 03/22/2024 04:59:04 PM


Document Has Been Signed on 03/22/2024 04:59 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: 3DATE:
03/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Administrator Napoleon FranciscoTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced visit to conclude the case management visit conducted on January 19, 2024. LPA Monter met with Administrator (ADM) Administrator Napoleon Francisco and stated the purpose of the visit. LPA Monter observed 3 residents and 3 staff members at the facility.

On January 19, 2024, the Department received an incident report stating on January 18,2024, resident, R1 was found in another resident’s bedroom, lying down on his/her back, breathing heavily. While assisting R1, staff contacted 911. The department was notified thru a subsequent incident report that R1 had passed away.

Based on a review of R1’s physicians report, dated March 17, 2023, R1 is a resident with developmental disabilities and underlying health conditions. Based on a review of R1’s Death Certificate, R1 passed away on January 18, 2024, due to complications of cardiovascular disease.

The Department has completed the investigation. Based on record reviewed, the Department has found that the allegation of neglect/lack of supervision were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited during today’s visit. A copy of the report was provided to ADM.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024
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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