<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201586
Report Date: 12/19/2023
Date Signed: 12/26/2023 08:31:53 AM

Document Has Been Signed on 12/26/2023 08:31 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
Lookup Error,
, CA
FACILITY NAME:SANDY'S RCH - REDMONDFACILITY NUMBER:
435201586
ADMINISTRATOR:ZIPAGAN, SANDYFACILITY TYPE:
735
ADDRESS:1065 REDMOND AVENUETELEPHONE:
(408) 472-2059
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY: 6CENSUS: 6DATE:
12/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Sandy ZipaganTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst's (LPA)'s L. Salazar and S. Doucette arrived at the facility unannounced to conduct a Required Annual Inspection. LPA's were greeted by Staff Lorena Punzalan, stated the purpose of the visit and were allowed entry into the facility.

LPA observed 6 residents in care at the time of visit. Facility temperature was 78 degrees F. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 105.2 degrees F.

Medications were observed to be locked in a cabinet located in the kitchen. Cleaning supplies were observed to be locked under the kitchen sink. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. There are no residents with Restricted Health conditions in the facility.

Carbon monoxide and smoke detectors were tested and observed to be operational. Night lights were observed in the hallways. Fire Extinguisher was observed with a service date of 06/02/23. First aid kit was observed and contained all required items.

The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed on the front porch for residents in care. Side gate was self-closing and self-latching.

Quarterly Emergency Disaster Drill logs were observed on 09/23/23 for staff. LPA observed on the LIC 610D (Emergency Disaster Plan). Facility files will be reviewed at a later date. An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Medina
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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 1