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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201992
Report Date: 02/28/2022
Date Signed: 02/28/2022 04:25:45 PM

Document Has Been Signed on 02/28/2022 04:25 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:TOUCH OF LIFE CARE HOMEFACILITY NUMBER:
435201992
ADMINISTRATOR:SHEILA ALDAFACILITY TYPE:
740
ADDRESS:3318 CERRITO COURTTELEPHONE:
(408) 528-7137
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 0DATE:
02/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:SHEILA ALDATIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection. Upon arrival, LPA pressed the door bell, ADM's sister opened the door, and stated the facility has no residents for 3 years.

ADM's sister let LAP enter the facility. No COVID posters on the main entrance. No any COVID posters inside the facility. No screening station at facility.

ADM's sister stated the facility has not been operating for 3 years. ADM's mother was observed at facility. ADM's sister stated ADM was working, and was unable to come back to facility.

LPA wanted to tour the facility, but ADM's sister stated she was not authorized to let LPA tour the facility. LPA spoke with ADM via phone. ADM stated that LPA needs to make an appointment, then ADM will stay at facility. LPA stated it is unannounced inspection visit.

ADM's sister stated she was not authorized to sign the document, and ADM's mother was to old to sign the document.

The facility was observed as non operational. LPA spoke to ADM on the phone that the facility should be closed if the facility is non operational.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2022
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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