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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202172
Report Date: 10/13/2021
Date Signed: 10/22/2021 12:19:41 PM

Document Has Been Signed on 10/22/2021 12:19 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:STURLA CARE HOMEFACILITY NUMBER:
435202172
ADMINISTRATOR:DUMANTAY, MARJORIEFACILITY TYPE:
735
ADDRESS:2644 STURLA DRTELEPHONE:
(408) 818-0134
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 0DATE:
10/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Marjorie DumantayTIME COMPLETED:
10:35 AM
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 Analyst (LPA) Joanne Roadilla conducted an unannounced Infection Control site visit today. This is a continuation of an attempted visit conducted on 10/13/21. LPA met with Administrator (ADM) Marjorie Dumantay.

The facility currently do not have clients at this time. LPA toured the facility inside and out with ADM. Facility was observed to have a designated entry point for universal symptom screening. Hand sanitizers were available.

All bathrooms were inspected and observed supplied with hygiene products. Bedrooms, kitchen, dining room, living room, and the outside grounds of the facility were inspected. All fire exit routes were and clear of obstructions. Medication cabinet was observed locked. Toxins, cleaning supplies, knives and sharp objects are secured. Facility also observed to have adequate supply of Personal Protective Equipment (PPEs).

LPA reviewed the facility COVID-19 related infection control policies and procedures with ADM including screening, social distancing, surveillance testing, disinfecting, staffing, training, isolation, PPE use and inventory.

No deficiencies issued per Title 22 of the California Code of Regulations. LPA reviewed report with, and a copy provided to Marjorie Dumantay.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Joanne Roadilla
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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