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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200853
Report Date: 01/22/2025
Date Signed: 01/22/2025 11:05:52 AM

Document Has Been Signed on 01/22/2025 11:05 AM - 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:ROSEMARIE'S RESIDENTIAL CARE HOME #2FACILITY NUMBER:
435200853
ADMINISTRATOR/
DIRECTOR:		OROSA, ROSEMARIE G.FACILITY TYPE:
735
ADDRESS:2726 SCOTTSDALE DRIVETELEPHONE:
(408) 528-7368
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 6DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:
Administrator Rosemarie G. Orosa		TIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Rosemarie G. Orosa, Administrator. LPA announced the purpose of the visit. LPA observed 3 staff. 0 out of 6 residents attending day program.

During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature measured with thermometer at 28 degrees F and freezer measured at -20 degrees F. Room Temperature was measured at 70 degrees F.

LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights, and 1 staff bedroom. LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 111-115 degrees F.

ADM tested the smoke detectors in the living and found the smoke detector to function properly when tested. LPA observed garage and laundry area used for laundry.

LPA toured the outside area and found the exits to be clear of obstructions. A shed was observed in the backyard and is being used as a storage and not as living quarters. LPA observed fire extinguisher was last serviced on 10/30/24. Facility has a Fire pull alarm and was serviced on 10/30/2024.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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: ROSEMARIE'S RESIDENTIAL CARE HOME #2
FACILITY NUMBER: 435200853
VISIT DATE: 01/22/2025
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LPA observed a collage of pictures of all the activities for the resident which included but not limited to Birthday party, Christmas Party, reading books and arts and crafts.

LPA reviewed Fire and Earthquake log and last disaster drill conducted on 1/04/25. LPA observed first aid kit complete with gauze, tweezers, scissors and first aid guide.

LPA reviewed resident records for 3 residents and 3 staff records and found them to be complete. P&I was reviewed by ADM and found to be complete. Centrally Stored Medication (CSMDR) was reviewed with ADM and found to be complete.

No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Rosemarie G. Orosa and a copy of this report was provided.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
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