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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202775
Report Date: 01/19/2024
Date Signed: 01/21/2024 10:06:18 AM


Document Has Been Signed on 01/21/2024 10:06 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:WATERMARK AT ALMADEN, THEFACILITY NUMBER:
435202775
ADMINISTRATOR:RONALD ELLENICHFACILITY TYPE:
740
ADDRESS:4610 ALMADEN EXPRESSWAYTELEPHONE:
(669) 258-4567
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:240CENSUS: 120DATE:
01/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Cheryl GraceTIME COMPLETED:
12:23 PM
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On 1/19/2024 Licensing Program Analysts (LPAs) Steve Chang and Mita Partoza, conducted an unannounced case management visit to follow up on the recent power outage. LPAs met with interim program director (IPD) Cheryl Grace. IPD called the maintenance director (MD) Wesley McKinley to explain their current situation.

MD stated - the facility has a temporary generator that is functioning. The current generator is able to sustain and provide the power that is needed to provide the basic services and necessity for the health. safety and well being of the residents. medical equipment, kitchen function, alarm system, lighting, water heating and elevator.

LPAs toured the following areas kitchen, medication room, food storage and supply, and resident rooms . LPAs observed that the facility is working at it's full capacity without any interruption to services and temperatures are maintained accordingly, refrigerator is at 40F and freezer is at 0F and has sufficient food supplies.

LPAS checked the room and water and temperature of the following residents (R1-R3). LPAs found that the water and room temperature measures from 68F to 74F and for water temperature measures from 109F to 116F

LPAs interviewed R1 to R3 and noted concerns expressed by the residents.

page 1 of 2 continued page 2 (LIC 809-C)
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: WATERMARK AT ALMADEN, THE
FACILITY NUMBER: 435202775
VISIT DATE: 01/19/2024
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continued from page 1

No deficiencies are noted for today's visit.

Exit interview was conducted with IPD Cheryl Grace. This report was reviewed and provided to IPD for signature and a hard copy was provided.

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end of report
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC809 (FAS) - (06/04)
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