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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202777
Report Date: 10/19/2022
Date Signed: 10/19/2022 04:53:02 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/19/2022 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:PADDINGTON ADULT RESIDENTIAL FACILITY INCFACILITY NUMBER:
435202777
ADMINISTRATOR:VALENZUELA, CECILIA SANOYFACILITY TYPE:
735
ADDRESS:1236 PADDINGTON WAYTELEPHONE:
(408) 770-9956
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 6CENSUS: 6DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Cecilia Valenzuela, ADMTIME COMPLETED:
12:38 PM
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Licensing Program Analysts (LPAs) Steve Chang and Simi Rai conducted an unannounced annual inspection visit, and met with administrator (ADM) Cecilia Valnezuela.

Upon arrival, ADM took LPAs' body temperature, and asked the screening questionnaires, then checked LPA in the visitor log book. COVID posters were observed in the facility. LPA toured the facility with ADM. There are two staff live-in rooms in facility. There are 3 shared rooms for residents, and 2 restrooms in facility. Beds in the resident rooms were observed 6 feet apart. Three staff and one residents were observed in the facility. Five residents went out for day program. LPA toured the kitchen, dining room, family room, and garage. LPA observed that all the trash cans with covers, and all the paper towels with holders. Some cloth towels were observed in kitchen..

The room temperature was 74 degree F. And the hot water temperature was 110 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet was observed locked. Cleaning chemical products were observed locked. PPE supplies were observed sufficient. Fire extinguisher was serviced on 08/18/2022. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine.
LPA toured backyard with ADM. No obstacles were observed blocked the walkway in the backyard.

ADM stated all the staff and residents are fully vaccinated and done with booster.

No allegation was issued today. Exit interview was conducted with ADM. A copy of this report was emailed to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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