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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202029
Report Date: 03/21/2024
Date Signed: 03/21/2024 04:35:27 PM

Document Has Been Signed on 03/21/2024 04:35 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:FLINTCREST HOUSEFACILITY NUMBER:
435202029
ADMINISTRATOR:FE PUNZALANFACILITY TYPE:
735
ADDRESS:2043 FLINTCREST DRIVETELEPHONE:
(408) 533-5124
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 6DATE:
03/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Administrator, Fe PunzalanTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Administrator (ADM) Fe Punzalan. LPA Rai observed 3 staff and 5 residents at the facility and 1 resident was attending day program.

During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed a locked shed which was used for storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.

LPA Rai toured the resident bedrooms. 3 out of 3 resident bedrooms had available bedding, drawers, and functioning lights.

The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 105.1 - 105.5 degrees F. The water temperature in the kitchen sink was 105.2 degrees F. Fire extinguisher was observed and inspected on 3/1/2024. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted on 3/3/2024.

LPA Rai reviewed facility records for 3 staff and 3 residents. LPA Rai reviewed resident medications and central stored medication records. LPA Rai reviewed LIC 405 Record of Client's/Resident's Safeguard Cash Resources and 3 out of 3 resident records reviewed were accurate.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator (ADM) Fe Punzalan and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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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