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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202278
Report Date: 08/25/2021
Date Signed: 08/25/2021 10:08:42 AM

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:CORINTHIAN SENIORCAREFACILITY NUMBER:
435202278
ADMINISTRATOR:ANITA TUBIG-NERIFACILITY TYPE:
740
ADDRESS:1785 COMMODORE DRIVETELEPHONE:
(408) 649-3526
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY:6CENSUS: 0DATE:
08/25/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Anita NeriTIME COMPLETED:
10:11 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 Ryker Heberle (LPA) conducted an on-site case management visit with Administrator Anita Neri (Admin) to conduct a closing inspection.

Facility was undergoing major renovation. LPA toured all rooms in the facility, including living room, bedrooms #2-5, 2 bathrooms, kitchen, dining room, laundry room, garage. and backyard. Bedroom #1 had been renovated into an extension of the living room. All resident personal belongings and medications noted to be removed from facility. No residents were seen during the visit.

Admin was unable to locate their license. Admin affirmed that they understood that closure of facility results in nullification of license.

No deficiencies noted during visit.

This report was reviewed with Anita Neri, Administrator and a hard copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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