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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202811
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:44:34 PM

Document Has Been Signed on 05/25/2022 02:44 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:SWEET CARE HOME IN GILROYFACILITY NUMBER:
435202811
ADMINISTRATOR:YALUNG, ELAINEFACILITY TYPE:
740
ADDRESS:318 CHURCHILL PLACETELEPHONE:
(510) 458-7231
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 6CENSUS: 5DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Roberta FernandezTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the annual required inspection focusing on infection control. LPA met with lead caregiver, Roberta Fernandez.

During visit, LPA toured the facility to include the office, resident rooms, bathrooms, kitchen, dining room, living room, and backyard. All fire exit routes were free and clear of obstruction. Medication, toxins, and sharped objects were observed secured.

Facility has a designated entry point for symptom screening and sign-in for all visitors and staff. Temperature taken upon entry. Hand sanitizer made available upon entry and throughout the facility. Visitor guidelines observed posted. Bathrooms supplied with hygiene products, paper supplies and hand washing sign. LPA observed facility to have a trash can with lid. LPA observed facility's PPE supplies. Facility clean and disinfects multiple times daily and as needed. The following posters observed to include symptoms of COVID, mask required, visitation guidelines, and social distancing. LPA reviewed facility's procedures to isolation and infection control training.

LPA informed staff to submit infection control plan to CCLD by 06/30/2022 and to review PIN 22-13-ASC for additional guidance.

No deficiencies cited during today's visit, per California Code of Regulations, Title 22. Advisory notes provided.

This report was reviewed with Roberta Fernandez and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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