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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202007
Report Date: 11/01/2024
Date Signed: 11/01/2024 12:26:43 PM

Document Has Been Signed on 11/01/2024 12:26 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:FLORA HOMEFACILITY NUMBER:
435202007
ADMINISTRATOR/
DIRECTOR:
ABELLA CABANAYANFACILITY TYPE:
734
ADDRESS:1446 FLORA AVE.TELEPHONE:
(408) 249-3979
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY: 5CENSUS: 4DATE:
11/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Abella CabanayanTIME VISIT/
INSPECTION COMPLETED:
12:30 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 Analysts (LPA) Santino Fortes and Manuel Monter conducted an unannounced annual inspection, and met with Administrator Abella Cabanayan. LPA's observed 3 staff and 4 clients.

LPAs toured the facility inside out including: kitchen, living room, family room and 1 staff office, staff area, 4 rooms and 1 restrooms. Restrooms observed to have non skid flooring. LPAs observed perishable food supply of at least two days and non-perishable food supply of at least seven days. Refrigerator temperature was observed at 36 degrees F and Freezer temperature was 0 Degrees F. During visit The front yard and backyard of the facility was also inspected. There was no obstruction to block the outdoor exits. One storage shed used to store supplies was observed to be locked. LPA observed Facility License and Resident Personal rights were posted.

LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. Room temperature was at 78.0 degree F, and hot water temperature was measured from resident bathroom at 108 degrees F. LPA inspected the facility first aid kit and it was observed to be complete. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested. Fire extinguishers were last serviced on 08/16/24. The facility conducted their last fire drill on 10/15/24.

LPA reviewed facility records for 3 staff and 4 residents. LPA reviewed 3 clients medications and centrally stored medication records. LPA reviewed 3 resident P&I records. LPA's interviewed 2 staff and 1 resident. LPA's observed residents participating in a November art activity.

No deficiencies were cited during today's visit as per California Code of Regulations Title 22. Exit interview was conducted with ADM. This report was reviewed and a copy was provided to ADM for signature.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Santino Fortes
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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