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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202646
Report Date: 07/26/2022
Date Signed: 07/26/2022 12:27:45 PM


Document Has Been Signed on 07/26/2022 12:27 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:MAGDALENE RESIDENTIAL CAREFACILITY NUMBER:
435202646
ADMINISTRATOR:LITERATO-HILARIO, FEFACILITY TYPE:
740
ADDRESS:1109 E HOMESTEAD RDTELEPHONE:
(408) 882-3926
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:6CENSUS: 4DATE:
07/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:FE LITERATO-HILARIOTIME COMPLETED:
12:35 PM
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On 07/26/2022, Licensing Program Analyst (LPA) Mandeep Kaur and Licensing Program Manager (LPM) Sarah Yip conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Administrator FE LITERATO-HILARIO. Upon entrance of the facility, LPA's and LPM's temperature were measured.

LPA and LPM observed the facility from outside including the 2 isolation rooms for 2 COVID Positive residents. Facility has 1 designated staff for the COVID 19 positive residents. LPA and LPM suggested the sign for the isolation rooms.

Facility observed to have designated entry point for COVID 19 symptom screening.
All staff members were observed to be wearing masks.

LPA and LPM observed the outside of the facility.

No citations were issued per the California Code of Regulations Title 22.

LPA will email the administrator to get the copy of the LIC 500 and LIC 610.

LPA reviewed the report with Administrator Fe LIterato-Hilario and copy provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Mandeep KaurTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022
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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