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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201853
Report Date: 01/23/2024
Date Signed: 01/23/2024 01:10:40 PM

Document Has Been Signed on 01/23/2024 01:10 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:SIERRA HEIGHTS MANORFACILITY NUMBER:
435201853
ADMINISTRATOR:MARIA CECILIA O. CLARIDADFACILITY TYPE:
735
ADDRESS:2975 COHANSEY DRIVETELEPHONE:
(408) 272-7432
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 6CENSUS: 4DATE:
01/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Maria Cecilia O ClaridadTIME COMPLETED:
01:09 PM
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Licensing Program Analyst (LPA) Mita Partoza and LIcensing Program Manager (LPM) Romeo Manzano conducted an unannounced annual inspection to the facility. LPA and LPM met with administrator (ADM) Maria Cecilia Claridad and two staff.

No clients are currently in the facility. Clients attends day program.

During visit, LPA and LPM toured the facility to include the living room, dining room, kitchen, bedrooms, bathroom, garage, and backyard. Staff room was inspected, 2 bathroom were inspected. The bathroom hot water temperature was measured at 105F, room temperature in the facility was at 68-75F.

LPA randomly reviewed resident and staff records including residents medication and P&I.
Perishable and non-perishable food supply are within required regulation. Toiletries such toilet paper, paper towels, toothpaste are inspected and found to be in ample supply. Toxic materials such as laundry detergent, disinfectant are inaccessible to residents (locked in a cabinet).

LPA tested the smoke/carbon monoxide and found to be in good working condition. Night lights are also observed and are in good working condition. All designated emergency exits and passage ways are clear from obstructions.

Staff and Administrator were interviewed and reminded about infection control plan.

LPA provided a letter of list of annual required document to be submitted on or before 1/30/2024 (such as LIC 500, LIC 308, lease agreement, et. seq.).

No deficiencies were cited per California Code of Regulations, Title 22 during today's visit. This report was reviewed with administrator Maria Cecilia Claridad.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2024
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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