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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202761
Report Date: 10/17/2023
Date Signed: 10/17/2023 03:24:01 PM

Document Has Been Signed on 10/17/2023 03:24 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:ARF SWEET CARE HOMEFACILITY NUMBER:
435202761
ADMINISTRATOR:CHEN, XIUYANFACILITY TYPE:
735
ADDRESS:3283 MOUNT EVEREST DRTELEPHONE:
(408) 946-8918
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 6CENSUS: 3DATE:
10/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Xiuyan ChenTIME COMPLETED:
03:30 PM
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On 10/17/2023, Licensing Program Analysts (LPA'S) Steve Chang & Manuel Monter conducted an unannounced visit to the facility. LPA's met with Administrator (ADM) Xiuyan Chen.

On 09/29/2023, the department conducted a non-compliance visit. LPA's observed a partition in the living room. ADM stated the partition is not a room for sleeping but a rest area.

On 10/17/2023, LPA's observed a futon in side the partition. ADM stated the partition is not being used as a staff bedroom. The partition is a rest area for the staff. Currently the staff are using 1 of the unoccupied rooms to rest. ADM stated he/she currently looking to have only 4 residents at the facility at this time.
(Note the partition dimensions are: 8(L) x 4.25 (W) x 6 (H) )

ADM stated the partition in the living room isn't a staff bedroom for sleeping. ADM stated the night staff is a wake night staff. LPA's requested LIC500.

ADM stated he/she will inform LPA and CCL if he/she decides to change one of the resident bedrooms to a staff room.

LPA interviewed staff S1. S1 stated he/she does not sleep at the facility.

No deficiencies cited, a copy of a report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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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