<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202779
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:29:05 PM


Document Has Been Signed on 09/10/2024 04:29 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:REAL ELDERLY CAREFACILITY NUMBER:
435202779
ADMINISTRATOR:ARIES GERONIMOFACILITY TYPE:
740
ADDRESS:4858 POSTON DRIVETELEPHONE:
(408) 440-2441
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:6CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Jocelyn RealTIME COMPLETED:
04:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Jocelyn Real.

LPA observed 4 staff and 2 residents in the facility. 2 residents went to day program. LPA reviewed 2 resident files and 2 staff files.

LPA toured the facility inside out with ADM. License, ADM Certificate, and Personal Rights posters were observed in the facility. Family room, kitchen, dinning room and two restrooms were inspected. Bar and non skid mats were observed in the restrooms. 2 shared resident bedrooms, 2 single resident rooms, laundry room, and garage were inspected. Staff break area was observed in the garage. Three half rail beds were observed in the bedroom. ADM stated the facility has the document for that but was unable to provide during the inspection. ADM stated to provide later. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 72 degree F, and hot water temperature was at 114 degree F in the facility. The temperature of the freezer was observed at -16 degree F and the temperature of the refrigerator was observed at 43 degree F. ADM tested the call button system, and it works fine.

Fire extinguisher was serviced on 08/15/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. Two storage rooms were observed at the backyard. There was no obstruction to block the walkways. Door alarm was observed installed at the main door. Flash lights, first aid box, and night light were observed in the facility. the last time the facility conducted the fire drill was on 8/18/2024.

No citation were noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 277-1289
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1