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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202242
Report Date: 02/21/2023
Date Signed: 02/22/2023 01:38:50 PM

Document Has Been Signed on 02/22/2023 01:38 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:EASTER HOMEFACILITY NUMBER:
435202242
ADMINISTRATOR:FLAMINGO R. LIGUTOMFACILITY TYPE:
735
ADDRESS:400 EASTER AVE.TELEPHONE:
(408) 263-8133
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 5DATE:
02/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Flamingo LigutomTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced annual inspection focusing on infection control. LPA met with Administrator Flamingo Ligutom.

LPA Rai observed 5 out of the 5 residents at the facility. LPA Rai observed 3 staff members, including the Administrator, at the facility.

During visit, LPA Rai toured the facility to include the activity room, office room, living room, 3 resident rooms, 2 bathrooms, kitchen, dining area and exterior. All fire exit routes are free and clear of obstruction. Toxins and sharp objects were secured.

Facility observed to have a designated central entry point to include a sign-in sheet and temperature check. Facility clean and disinfect as often as needed. Bathrooms supplied with hygiene products and hand washing sign. Trash can with lid observed. LPA observed a sufficient amount of Personal Protective Equipment (PPE).

The following posters observed to include wash your hands, symptoms of COVID-19, and social distancing.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator Flamingo Ligutom and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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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