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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202761
Report Date: 09/15/2021
Date Signed: 09/16/2021 08:54:37 AM

Document Has Been Signed on 09/16/2021 08:54 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 0DATE:
09/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Xiuyan Chen, ADMTIME COMPLETED:
10:39 AM
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At 9:10AM, Licensing Program Analyst (LPA) Steve Chang arrived at the facility. Upon arrival, LPA saw a lady went out. LPA asked the lady where she was going. The lady answered she was going to work. Administrator (ADM) Xiuyan Chen opened the door for LPA. LPA addressed the purpose of today's visit to ADM. ADM stated there is no client in the facility. ADM stated the facility is non operational. No COVID-19 signs were observed in the facility. There was no thermometer in the facility.

LPA toured the facility with ADM. LPA inspected the living room, kitchen, 2 restrooms, and 5 bedrooms. ADM stated one bedroom is for ADM. ADM stated one bedroom is for ADM's friend. ADM stated ADM's friend is leaving in this month. ADM stated ADM's friend lives in the room since June 2021.

The facility is in non operational status. ADM stated the facility never has clients. ADM stated ADM plans to either close the facility or to sell to others. The facility received the license on September 2020.

LPA told ADM to send LPA a letter specifying the reason to close the facility if ADM wants to close the facility. ADM stated ADM will make a decision within 30 days.

No citation was issued during today's inspection. Exit interview conducted with ADM. This report was provided to ADM to review and to sign. A copy of this report was email to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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