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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202340
Report Date: 01/26/2023
Date Signed: 01/26/2023 04:54:17 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/26/2023 04:54 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:VENETIAN RESIDENTIAL CARE, INC.FACILITY NUMBER:
435202340
ADMINISTRATOR:PAZ BILKEYFACILITY TYPE:
740
ADDRESS:4649 VENICE WAYTELEPHONE:
(408) 873-1670
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:6CENSUS: 4DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Virginia Quezada, House MangerTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with House Manager (HM) Virginia Quezada .

Upon Arrival, HM took LPA's body temperature, and checked LPA in the visitor log book. LPA observed the COVID posters in the facility. Four residents were observed in facility.

LPA toured the facility with HM inside and out. LPA inspected living room, family room, dinning room and kitchen. There are two restrooms for residents, one restroom for staff, 2 resident shared rooms, 2 resident single rooms, and 1 staff live-in room in facility. Trash cans were observed with covers. Posters of washing hands were observed by the sinks in kitchen and restrooms, but no posters of washing hands for 20 seconds were observed in kitchen and restrooms. HM stated the facility will put posters of washing hands for 20 seconds by the sinks in kitchen and restrooms in 3 days. Two days perishable foods and seven nonperishable foods were observed sufficient. Room temperature was observed at 73 degree F, hot water temperature was observed at 110 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. PPE supplies were observed sufficient. Fire extinguisher was serviced on 5/6/2022. The facility was equipped with smoke and carbon monoxide detectors. Smoke detector alarm system was tested, and was working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. During the inspection, Administrator PAZ BILKEY (ADM) also came in facility.

ADM stated all the residents and staff are fully vaccinated and done with booster shots The facility already submitted the Infection Control Plan to LPA..

No citation was issued today. Exit interview was conducted with HM. This report was provided to HM for signature. A copy of this report was emailed to HM.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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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