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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200791
Report Date: 04/05/2024
Date Signed: 04/05/2024 02:38:47 PM


Document Has Been Signed on 04/05/2024 02:38 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:CONSTANTIN'S CARE HOMEFACILITY NUMBER:
435200791
ADMINISTRATOR:LAPUSTEA, CONSTANTINFACILITY TYPE:
740
ADDRESS:5836 ETTERSBERG DRIVETELEPHONE:
(408) 229-0365
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:6CENSUS: 6DATE:
04/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Rodica LapusteaTIME COMPLETED:
02:45 PM
NARRATIVE
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On 4/5/2025 at 10:45 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived unannounced to conduct an annual required inspection. LPA met with Rodica Lapustea staff and caregiver. Administrator (ADM) Constantin Lapustea was currently unavailable. Staff called ADM and stated that he was picking up a guest from Romania and will be in the facility in 45 minutes. ADM stated staff is authorized to sign reports and accompany LPA when touring the facility. ADM arrived at around 12:15 p.m.

The facility has a current census of 6 residents. During the time of the visit 4 out 6 resident were out on a day program.

LPA observed the facility temperature measured at 70 degrees F. The hot water temperature measured at 109 to 112 degrees F. There were working lights in each room. There are grab bars for each toilet and shower. Bathrooms had non-skid mats. Supplies of personal hygiene items were available. The facility had combination smoke and carbon monoxide detectors that were tested and functioning properly. Fire Extinguishers were inspected on 1/28/2024. The last emergency disaster drill was on 1/29/2024. Medications are stored in a locked cabinet in the office. Knives are locked in a drawer in the kitchen. Toxins and cleaning supplies are locked in a cabinet in the garage. LPA observed 2 days of perishable food and 7 days of non-perishable food. LPA observed the emergency plan, exit plan, Long-Term Care Ombudsman, posted on the wall.

Residents and staff records were reviewed. Resident records have the following admission agreement, medical assessment with TB test information, updated needs and services plan, and personal rights, the centrally stored medication record were up to date. Advisory note was given to the administrator.

page 1 continued to page 2 LIC 809C.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: CONSTANTIN'S CARE HOME
FACILITY NUMBER: 435200791
VISIT DATE: 04/05/2024
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Facility staff all have criminal record clearance to work at the facility and are associated to the facility. Staff records have the following personnel record, health screening with TB test information, criminal record statement, and current first aid certificate. Administrator certificate renewal was sent on 10/18/2023 with appropriate training requirement.

The following forms to be updated and submitted to CCL 4/15/2024
LIC 500 Personnel Record
LIC 610E Emergency Disaster Plan
Limited Liability Insurance

During today's visit no deficiency was cited. An exit interview was conducted with the administrator Constantin Lapustea.

end or report
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC809 (FAS) - (06/04)
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