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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202511
Report Date: 03/19/2025
Date Signed: 03/19/2025 02:29:20 PM

Document Has Been Signed on 03/19/2025 02:29 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:CLUB RIVIERAFACILITY NUMBER:
435202511
ADMINISTRATOR/
DIRECTOR:		MUSTAFA SABANKAYAFACILITY TYPE:
735
ADDRESS:171 SOUTH 11TH STREETTELEPHONE:
(408) 289-1644
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 49CENSUS: 34DATE:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Maria CanizalesTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required 1 year annual inspection. LPA met with Program Director, Maria Canizales.

During visit, LPA toured the facility with the PD to include the common areas, dining room, kitchen, resident bedrooms, bathrooms, and exterior. All fire exit routes were free and clear of obstruction. Fire extinguishers last serviced on 9/18/2024. Facility has smoke detectors and carbon monoxide detectors present. Chemicals, disinfectants, and sharp objects observed locked. Facility temperature maintained at 71 degrees F.

LPA entered into 9 resident bedrooms with the help of the PD. Resident bedrooms are equipped with beds, linens, night stands, closet space, and adequate lighting. No concerns observed regarding the resident bedrooms. The hot water temperature on the first floor measured at 118 degrees F. The hot water temperature on the second floor measured between 124.7 - 129.9 degrees F. PD stated they will lower the hot water temperature in the women's bathroom on the second floor.

The kitchen refrigerator temperature maintained at 36 degrees F. The kitchen is locked, however, staff assist the residents in storing personal items in the kitchen refrigerator. The main food supply is located at Ali Baba #1 #430700017. LPA observed the facility has at least 7 days worth of non-perishables and 2 days worth of perishable foods. The facility has accessible drinking water available in the dining room. The facility's activity calendar is posted in the dining room. LPA observed residents participating in activities during visit. Page 1 of 2.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: CLUB RIVIERA
FACILITY NUMBER: 435202511
VISIT DATE: 03/19/2025
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4 resident files were reviewed and observed complete. 4 residents centrally stored medications and centrally stored medication records were reviewed and no issues were noted. The 4 residents do not have P&I money.

4 staff files were reviewed and observed complete to include the staffs annual training records.

The facility has a first aid kit located in the medication room. Extra emergency lighting was observed. Fire drills are being completed quarterly and the last drill was on 11/14/2024.

No deficiencies was cited per California Code of Regulations, Title 22. This report was reviewed with Program Director, Maria Canizales and a copy of the report and was provided.

Page 2 of 2.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
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