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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202608
Report Date: 10/28/2024
Date Signed: 10/28/2024 05:24:45 PM

Document Has Been Signed on 10/28/2024 05:24 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:DIYA SENIOR CARE CORPORATIONFACILITY NUMBER:
435202608
ADMINISTRATOR/
DIRECTOR:
BHATIA, JASRAJFACILITY TYPE:
740
ADDRESS:366 LASSENPARK CIRTELEPHONE:
(408) 226-1162
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
10/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:39 AM
MET WITH:Bani KaurTIME VISIT/
INSPECTION COMPLETED:
01:26 PM
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Licensing Program Analyst (LPA) conducted an unannounced annual inspection visit and met with Administrator (ADM) Bani Kaur.

LPA inspected 3 staff files and 3 residents files.

LPA toured the facility with ADM. Personal rights poster, Licensee, Administrator Certificate were observed at the main entrance. 3 shared resident bedrooms, two restrooms, and laundry room were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet were observed locked. Room temperature was at 70 degree F, and hot water temperature was at 112 degree F in facility. 2 staff and 5 residents were observed in the facility.

3 staff rooms, one restroom, and 1 storage room were observed on the second floor. One of the staff S1 was observed without health screening record. ADM stated S1 has the health screen form. ADM stated he/she will provide a copy of it later.

Fire extinguisher was serviced on 09/9/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. First aid box and flash lights were observed in the facility. The last time the facility conducted the emergency drill is 5/1/2024.

Front yard and backyard were inspected. There was no obstruction to block the walkways.

Exit interview was conducted with ADM. The report was provided to ADM for signature.
Romeo ManzanoTELEPHONE: (408) 277-1289
Chihhsien ChangTELEPHONE: (408) 904-9843
DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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