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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202503
Report Date: 04/29/2022
Date Signed: 04/29/2022 03:36:32 PM


Document Has Been Signed on 04/29/2022 03:36 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:HEALTHY LIVING RESIDENTIAL CARE HOMEFACILITY NUMBER:
435202503
ADMINISTRATOR:MADELINE TAM CHOWFACILITY TYPE:
740
ADDRESS:251 DELIA STREETTELEPHONE:
4084936955
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:6CENSUS: 5DATE:
04/29/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Xiuyan ChenTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced inspection visit for Senior Sweet care home, and met with administrator (ADM) Xiuyan Chen.

LPA toured the facility inside out with ADM. Living room, dinning room, kitchen, 4 bedrooms, 3 bathrooms and laundry room were observed and inspected. Backyard and front yard were observed and inspected. No deficiencies were observed. All the residents and staff of the old facility are transferred to new facility.

ADM stated this is a change owner case for the facility.

Exit interview was conducted with ADM. This report was provided to ADM for signature.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
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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