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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202673
Report Date: 03/12/2024
Date Signed: 03/12/2024 04:24:09 PM

Document Has Been Signed on 03/12/2024 04:24 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:LA PAZ RESIDENTIAL CARE HOMEFACILITY NUMBER:
435202673
ADMINISTRATOR:JAURIQUE, BETTY JEANFACILITY TYPE:
735
ADDRESS:356 MADISON DRTELEPHONE:
(408) 674-9610
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 5DATE:
03/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Staff, Ariana MorenoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Simi Rai conducted an case management visit to follow up on deficiency cited during the annual inspection conducted on 12/29/2022. LPA Rai met with Staff Ariana Moreno and stated the purpose of the visit.

On 12/29/2022, the Licensee was cited facility for hot water temperatures for personal care in the restroom measuring at 136.9 degrees F. Per California Code of Regulation Title 22, hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

During today's visit, LPA measured the water temperature in 2 out of 2 bathroom sinks. LPA observed the temperatures to range from 116.6 degrees F to 117.0 degrees F.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Staff Ariana Moreno. A copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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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