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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201853
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:23:20 AM

Document Has Been Signed on 01/15/2025 11:23 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:SIERRA HEIGHTS MANORFACILITY NUMBER:
435201853
ADMINISTRATOR/
DIRECTOR:		MARIA CECILIA O. CLARIDADFACILITY TYPE:
735
ADDRESS:2975 COHANSEY DRIVETELEPHONE:
(408) 272-7432
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 6CENSUS: 4DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Maria Cecilia O. ClaridadTIME 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 Maria Cecilia O.Claridad, Administrator. LPA announced the purpose of the visit. LPA observed 1 staff and 1 out of 4 resident waiting for ride for day program, 3 of 4 residents at 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 39 degrees F. LPA observed room temperature to be at 71 degrees F.

LPA toured four resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA tested the smoke detectors in the hallway and three resident bedrooms and found the smoke detector to function properly when tested by the administrator. 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 between 107 to 112 degrees F.

LPA toured the outside area and found the exits to be clear of obstructions, 2 sheds were observed locked and being used as storage and not living quarters. LPA observed fire extinguisher was last serviced on 02/18/24. LPA reviewed Fire and Earthquake log and last disaster drill was last conducted on 1/4/25.

LPA reviewed resident records for 3 residents and found to be complete LPA reviewed 3 staff records and found them to be complete. Resident P&I was also 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 Maria Cecilia O.Claridad and a copy of this report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 01/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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