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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201251
Report Date: 06/05/2024
Date Signed: 06/05/2024 04:42:20 PM


Document Has Been Signed on 06/05/2024 04:42 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:PRONTO CARE HOMEFACILITY NUMBER:
435201251
ADMINISTRATOR:DIANA NATIVIDADFACILITY TYPE:
740
ADDRESS:771 PRONTO DRIVETELEPHONE:
(408) 226-9838
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:6CENSUS: 5DATE:
06/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Diana NatividadTIME COMPLETED:
04:50 PM
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On 6/5/2024, Licensing Program Manager (LPM) Romeo Manzano and LIcensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced plan of correction (POC) visit and was met by the staff (S1) and resident (R1). Administrator (ADM) Diana Natividad was called by S1 and arrived at a facility after 15 minutes.

During the tour, LPM and LPA, observed that the facility addressed the 2 Out of 2 of maintenance requirement deficiencies that was cited on 5/22/2024 and was cleared - [CCR 87303(a)(1)]

At the time of the visit, LPM and LPA, reviewed 4 out of 5 resident appraisals needs and services plan, and physicians' medical assessment. 5 out of 5 resident have neurocognitive impairment. 2 out of 5 are ambulatory and 3 out of 5 are non-ambulatory.

Based on the document review the physicians report (LIC 602) needs to be updated. 5 Out of 5 residents needs to be scheduled to visit their PCPs (primary care physicians) need to update the LIC 602 to state the most current assessment. The needs and services plan of 5 out of 5 residents needs to be updated by the plan of correction due date as originally planned. LPA discussed that appraisal needs and services plan needs to be discussed with responsible parties and the resident. LPA deadline for this deficiencies is not due until 6/7/2024.

ADM will notify LPA once the residents have been scheduled with their corresponding PCPs for re-assessment.

During today's visit LPA discussed the bladder incontinent of 5 out of 5 resident with ADM and asked ADM to submit a plan to address the issue of bladder incontinence. LPA discussed the department's TSP (Technical Service Program) for record maintenance.

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SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
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: PRONTO CARE HOME
FACILITY NUMBER: 435201251
VISIT DATE: 06/05/2024
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No deficiencies were cited during today's visit per California Code of Regulation (CCR) Title 22. An exit interview was conducted with ADM Diana Natividad and a copy of the report was provided.

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

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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