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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201527
Report Date: 02/24/2025
Date Signed: 02/24/2025 11:19:37 AM

Document Has Been Signed on 02/24/2025 11:19 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:CAPRI HOME IIFACILITY NUMBER:
435201527
ADMINISTRATOR/
DIRECTOR:
GANIYU AJANIFACILITY TYPE:
735
ADDRESS:324 SAN ANDREAS COURTTELEPHONE:
(408) 586-8476
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 3CENSUS: DATE:
02/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Leah Contaoi Designated AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Leah Contaoi, Designated Administrator. LPA announced the purpose of the visit. LPA observed 1 resident and 3 staff, 2 residents went to 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. First aid kit was observed to be complete.

LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature was measured with thermometer at 41 degrees F and freezer at 0 degrees F.

LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA toured 1 resident bathroom. Bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 106.3 degrees F.

LPA toured the outside area and found the exits to be clear of obstructions. LPA observed 3 fire extinguishers last serviced on 12/19/24. LPA reviewed Fire and Earthquake log last disaster drill was last conducted on 01/06/25.

LPA reviewed 3 staff records. LPA reviewed 2 resident files. ADM reviewed P & I and Centrally Stored Medication Record.

No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Leah Contaoi, Designated Administrator and a copy of this report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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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