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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202643
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:49:44 PM

Document Has Been Signed on 01/07/2025 04:49 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:AMY'S RESIDENTIAL CARE, INC.FACILITY NUMBER:
435202643
ADMINISTRATOR/
DIRECTOR:
BHAVANDEEP MANNFACILITY TYPE:
740
ADDRESS:671 N WHITE RDTELEPHONE:
(408) 898-8784
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 6CENSUS: 6DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Amarjeet MannTIME VISIT/
INSPECTION COMPLETED:
02:59 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Amarjeet Mann. During visit, LPA observed 6 residents and 2 staff.

LPA reviewed 3 resident files and 3 staff files.

LPA toured the facility inside and out with ADM. License, Personal Rights posters, and Administrator Certificate were observed in the facility. LPA inspected living room, family room, dinning room, kitchen, and garage. There are 3 restrooms, 6 resident single rooms, and 2 staff rooms in facility. Two days perishable foods and seven non perishable foods were observed sufficient. Room temperature was observed at 72 degree F, hot water temperature was observed at 114 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. Fire extinguisher was serviced on 11/05/2024. The facility is equipped with fire/smoke and carbon monoxide detectors. carbon monoxide detector was tested, and was functional. First aid box, flash lights, and night nights were observed in the facility. ADM provided the 4 residents' physician report for using bed rails.

Front yard and backyard were inspected. There was no obstruction to block the walkways. Two storage rooms were observed in the backyard.

LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 3 restrooms and 7 residents bedrooms. Front yard and backyard were inspected. There was no obstruction to block the walkways. The last time the facility conducted the emergency drill was on 10/20/2024.

No citation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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