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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
435200791
Report Date:
04/29/2022
Date Signed:
04/29/2022 01:55:27 PM
Document Has Been Signed on
04/29/2022 01:55 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:
CONSTANTIN'S CARE HOME
FACILITY NUMBER:
435200791
ADMINISTRATOR:
LAPUSTEA, CONSTANTIN
FACILITY TYPE:
740
ADDRESS:
5836 ETTERSBERG DRIVE
TELEPHONE:
(408) 229-0365
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95123
CAPACITY:
6
CENSUS:
5
DATE:
04/29/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:07 PM
MET WITH:
Rodica Lapustea
TIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Rodica Lapustea.
LPA Marrufo toured the inside and outside of the facility. LPA Marrufo observed there to be a visitor screening area at the facility entrance. LPA Marrufo observed there to be a PPE supply of at least 30 days. LPA Marrufo observed there to be a perishable food supply of at least 3 days and a non-perishable food supply of at least 7 days. LPA Marrufo toured 2 out of 2 bathrooms and observed there to be available soap and paper towels and hand washing signs.
LPA Marrufo toured the outside of the facility and found the exits were clear of obstructions.
No deficiencies were cited as per California Code of Regulations Title 22.
This report was reviewed with Rodica Lapustea and a copy of the report was provided.
SUPERVISOR'S NAME:
Jackie Jin
TELEPHONE:
(714) 319-3786
LICENSING EVALUATOR NAME:
David Marrufo
TELEPHONE:
(650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE:
04/29/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/29/2022
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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