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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202408
Report Date: 02/12/2025
Date Signed: 02/12/2025 04:50:05 PM

Document Has Been Signed on 02/12/2025 04:50 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:BRIGHT HAVEN MANORFACILITY NUMBER:
435202408
ADMINISTRATOR/
DIRECTOR:
MARIESON FLOREZAFACILITY TYPE:
735
ADDRESS:2706 WILBUR AVENUETELEPHONE:
(408) 629-8804
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 6CENSUS: 5DATE:
02/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Marieson FlorezaTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with administrator (ADM) Marieson Floreza. 2 staff and 5 residents were observed in the facility.

LPA reviewed 3 resident files and 3 staff files.

LPA toured the facility inside and out with ADM. License, personal rights poster were observed in the facility. Administrator Certificate was observed expired. ADM stated he/she already renewed it. LPA observed administrator's ADM Certificate is on the pending list online. LPA inspected living room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product cabinet were observed locked. There are three shared resident rooms, one office, and one multiple purpose room in facility. 2 bathrooms were inspected. 2 days perishable food supplies and 7 days non perishable food supplies were observed sufficient. Room temperature was observed at 68 degree F, and hot water temperature was observed at 118 degree F. The temperature of the refrigerator was at 45 degree F, and the temperature of the freezer was at 0 degree F.

The facility is equipped with carbon monoxide detectors and fire alarm detectors. ADM tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 07/17/2024. First aid box, flash lights, and night lights were observed in the facility. The facility's last time emergency and fire drill was conducted 1/31/25.

LPA inspected the backyard, there was no obstruction to block the walkway.

No citation noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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