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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202205
Report Date: 09/19/2024
Date Signed: 09/23/2024 09:05:24 AM

Document Has Been Signed on 09/23/2024 09:05 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:SANTOS CARE HOMEFACILITY NUMBER:
435202205
ADMINISTRATOR/
DIRECTOR:
MICHELLE S. SANTOSFACILITY TYPE:
735
ADDRESS:1706 MT. RANIER AVE.TELEPHONE:
(408) 469-7154
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 6DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Michelle SantosTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analysts(LPA) Steve Chang and Santino Fortes conducted an unannounced annual inspection, and met with Administrator Michelle Santos. ADM informed that facility has 2 staff and 6 clients.

LPAs toured the facility inside out including: kitchen, living room, family room and 1 staff room, 3 shared resident rooms and 2 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 43 degrees F and Freezer temperature was -2 Degrees F. Dish soap was observed to be stored on the kitchen counter next to the hand soap. During visit ADM stored the dish soap with the sharps to correct. There was no hallway lighting observed. ADM installed a night light in the hallway during inspection. The front yard and backyard of the facility was also inspected. There was no obstruction to block the outdoor exits. LPA observed Facility License and Resident Personal rights were posted. One storage shed was observed to be locked and used for storage purposes.

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 73.0 degree F, and hot water temperature was measured from resident bathroom at 105.6 degrees F. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested. Fire extinguishers were last serviced on 9/3/24. LPA observed the facility first aid kit and it was observed to be complete. The facility fire/earthquake drill log was reviewed. The facility's last drill was on 7/16/24.

LPA reviewed facility records for 3 staff and 3 clients. LPA reviewed 3 clients medications and centrally stored medication records.

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: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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