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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201922
Report Date: 12/21/2022
Date Signed: 12/27/2022 08:22:42 AM

Document Has Been Signed on 12/27/2022 08:22 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:SYLVAN HOMEFACILITY NUMBER:
435201922
ADMINISTRATOR:MENDINUETO, VERONICAFACILITY TYPE:
735
ADDRESS:3134 SYLVAN DRIVETELEPHONE:
(408) 223-1427
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 6DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee Veronica MendinuetoTIME COMPLETED:
04:30 PM
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On 12/21/2022 at 3:00pm, Licensing Program Analyst (LPA) Simi Rai conducted an unannounced annual required inspection and met with Licensee/Administrator, Veronica Mendinueto.

During visit, LPA Rai toured the facility to include the family room, dining room, 3 bedrooms, 2 bathrooms, garage, and backyard. All fire exit routes were free and clear of obstruction. All staff observed wearing a face covering.

Facility has a designated entry point for sign-in, symptom screening, and temperature check for all visitors and staff. Hand sanitizer made available at entry and throughout the facility. Visitation guidelines posted at the entrance. Bathrooms supplied with hygiene products, paper supplies, and hand washing sign. LPA Rai observed facility's Personal Protective Equipment (PPE) supplies. Facility has procedures to isolation and testing for COVID-19. Staff are trained on infection control. Staff are N95 fit tested. Facility staff clean and disinfect multiple times daily and as needed. The following posters observed to include wash your hands and symptoms of COVID-19.

No deficiencies were cited per California Code of Regulations, Title 22. Technical Violation notes were provided.

This report was reviewed with Licensee/Administrator, Veronica Mendinueto and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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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