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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200791
Report Date: 04/27/2024
Date Signed: 04/28/2024 06:48:23 PM


Document Has Been Signed on 04/28/2024 06:48 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:
04/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Michelle McWilliams - staff/caregiverTIME COMPLETED:
11:30 AM
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On 4/27/2024 - Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced visit to the facility. LPA stated the purpose of the visit is to deliver a finding for a complaint that was received by the department on 3/29/2022. LPA was greeted by the staff's (S1) child who is a minor (M1). LPA conducted a case management based on today's visit.

LPA arrived at 9:00 a.m. M1 stated that the licensee/administrator (LIC/ADM) Constantin Lapustea and caregiver was out. M1 stated he/she is the child of the staff who is currently accompanying and assisting residents with their walk and will be back in 15 minutes. LPA observed that M1 was alone with 2 residents (R1 to R2) and feeding one of the resident (R1).

At 9:30 a.m. 3 residents (R3 to R5) with the staff (S1) came in after their walk around the neighborhood. One of the resident (R3) approached LPA and made their introduction. S1 introduced self and stated that he/she is the caregiver for today and LIC/ADM are not in the facility at the moment and are currently at church. LPA conducted a facility inspection and observed that 5 out 6 residents were present in the facility.

During the visit LPA interviewed S1. S1 stated that she is not fingerprinted and not background cleared. S1 stated that she has been working at the facility since September 2023 and works at the facility every other weekends from 6:00 a.m. to 2:30 p.m.

LPA - checked Guardian and found that S1 is not associated with the facility and does not have background clearance. LPA interviewed residents (R3 and R4).

Continued on page 2 LIC 809C
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: 04/27/2024
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LPA toured the facility and checked bathroom, kitchen and residents' room. LPA observed that the drawer for knives were unlocked and key was in the key hole. The cabinet under the sink was unlocked with chemicals that are accessible to residents. 3 out of 3 bathroom under the sink cabinet is not locked and chemicals were easily accessible.

LPA observed that the medications for the day was in the cabinet and are easily accessible. No staff is trained to administer medication and administer first aid to residents.

On 4/27/2024 at 11:04 a.m. S1 stated that he/she is not authorized and is not comfortable to sign the report.

A citation will be issued at a later date. The licensee/administrator was not present in the facility at the time of the visit. A copy of the report was left with S1 and an exit interview was conducted.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2024
LIC809 (FAS) - (06/04)
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