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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200751
Report Date: 12/19/2024
Date Signed: 12/19/2024 04:49:50 PM

Document Has Been Signed on 12/19/2024 04:49 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:MUNA'S RESIDENTIAL CARE HOME IFACILITY NUMBER:
435200751
ADMINISTRATOR/
DIRECTOR:		EMAD QADDURAFACILITY TYPE:
735
ADDRESS:4232 INDIGO DR.TELEPHONE:
(408) 979-9265
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 6CENSUS: 6DATE:
12/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:18 AM
MET WITH:Emad QadduraTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with administrator (ADM) Emad Qadura.

Three staff were observed in facility. 4 residents went to day program, 1 resident went to work, and 1 resident went to day program for interview. License, Administrator certificate, and personal rights posters were observed in the facility.
LPA toured the facility with ADM inside and out. LPA inspected living room, family room, dinning area, kitchen and garage. There are 2 restrooms, 1 staff live-in room, and 3 resident rooms in facility. Two days perishable foods and seven day nonperishable foods were observed sufficient. LPA observed the thermometer in the refrigerator was at temperature of 55 degree F, ADM stated the thermometer is not working. ADM put another thermometer in the refrigerator and freezer. The temperature of the refrigerator was measured at 40 degree and the temperature of the freezer was measured at 0 degree F. Room temperature was observed at 68 degree F, and hot water temperature was observed at 119 degree F. Medication cabinet, Knife closet were observed locked. Dish washing solution bottle was observed on the top of the sink in the kitchen, ADM put the dish washing solution bottle in the cabinet under the sink in the kitchen and locked it immediately. The facility was equipped with smoke and carbon monoxide detectors. Smoke detector alarm system was tested, and was working fine. Fire extinguisher was serviced on 4/25/2024. First aid box, flash lights, and night lights were observed in the facility.

Front yard and backyard were inspected. One storage room was observed in the backyard. One washer machine and a dryer machine were observed in the backyard, ADM stated he/she bought used ones and will replace the existing washing machine and dryer machine.
The last time the facility conducted the fire drill was 9/11/2024.
No citation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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