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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202775
Report Date: 01/26/2024
Date Signed: 01/26/2024 04:53:29 PM


Document Has Been Signed on 01/26/2024 04:53 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: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: 118DATE:
01/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Resident Care Director, Angel BustosTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Type A and Type B deficiencies cited on 1/11/2024. LPA Rai met with Resident Care Director (RCD) Angel Bustos and stated the purpose of today's visit.

During visit, LPA Rai toured the Memory Care Unit along with Memory Care Director, Leann Marquez and Resident Services Coordinator, Jacque Bercellano. LPA Rai observed the common bathrooms and resident rooms unlocked and accessible for residents.

LPA Rai observed the In-Service training for "Public Restroom Accessibility" dated 1/12/2024, "Keeping Apartment Doors and Public Restroom Unlocked at All Times" dated 1/12/2024, and "Logging of Medications in Centrally Stored Medication and Destruction Record" dated 1/26/2024. LPA Rai observed the weight log for Assisted Living residents initiated for January 2024. LPA Rai observed a printed copy of the Monthly Weight Report and RCD stated a printed copy of the Weight Log for all residents is in a dedicated binder in the Medication Room. LPA Rai observed R1's updated Physician's Report dated 1/26/2024.

LPA Rai met with Maintenance Director, Wes McKinley, who stated the repairs on the facility's electrical system is on schedule. Facility will continue to provide updated to the Department.

On 1/19/2023, the Department checked the room and water temperatures of the following residents (R2-R4). LPAs observed the room temperature measures from 68F to 74F and water temperature measures from 109F to 116F.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Resident Care Director, Angel Bustos and a copy of the report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit RaiTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
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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