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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202242
Report Date: 08/08/2024
Date Signed: 08/08/2024 03:34:48 PM

Document Has Been Signed on 08/08/2024 03:34 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/
DIRECTOR:		FLAMINGO R. LIGUTOMFACILITY TYPE:
735
ADDRESS:400 EASTER AVE.TELEPHONE:
(408) 263-8133
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 5DATE:
08/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Flamingo R. Ligutom TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 8/8/2024 at 3:00 p.m. Licensing Program Analysts (LPAs) Maria (Mita) Partoza and Marcella Tarin, conducted an unannounced case management - deficiencies visit and was greeted by the administrator (ADM) Flamingo Ligutom and 2 staff.

AT 3:10 p.m. LPAs toured the facility inside and outside, including but not limited to the kitchen, dining, bathroom, backyard, living room and garage. During the visit LPAs observe 5 residents, 2 of 5 in the living room and 3 of 5 in their bedrooms. LPAs observed that deficiencies cited on 2/21/2024 were corrected.

LPAs observe the all exits were free from obstruction, the living room was sanitary and free from any debris, the staff was busy preparing dinner, sharps and knives were not accessible and kept in a locked drawer. The medication cabinet was locked and not accessible to the residents. ADM showed LPAS the repaired roof and the patio was cleared of obstruction.

No deficiencies were cited during today's visit per California Code of Regulations (CCR) Title 22 and deficiencies from the annual inspection have been corrected and resolved.

An exit interview was conducted with administrator Flamingo R. Ligutom. A copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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