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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202829
Report Date: 12/16/2023
Date Signed: 12/16/2023 05:10:49 PM

Document Has Been Signed on 12/16/2023 05:10 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:BETTER LIVING RCHFACILITY NUMBER:
435202829
ADMINISTRATOR:BASA, SHARONFACILITY TYPE:
735
ADDRESS:7459 PEGASUS CTTELEPHONE:
(408) 224-6224
CITY:SAN JOSESTATE: CAZIP CODE:
95139
CAPACITY: 6CENSUS: 6DATE:
12/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Staff member Shirle AsuncionTIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff member Shirle Asuncion (S1) . During visit, LPA observed 5 residents and 4 staff. S1 called Administrator (ADM) Sharon Basa. ADM stated S1 can sign on her behalf.

LPA toured the facility inside out with S1 which included; the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. While touring the residents bedrooms, LPA observed bedroom 2 & 3 did not have a night stand. (Photograph was taken). LPA asked S1 for ADM's phone number. LPA called ADM, and ADM confirmed that both bedrooms did not have nights stands. The staff area of the facility was also inspected. Front yard and backyard were inspected.

While touring the facility LPA observed a stack of 3 green chairs blocking the front door entrance obstructing (Photograph was taken.) While touring the backyard, LPA observed a cleaning powder, Comet, accessible to residents in care. The container was located directly outside of the kitchen/dinning area. S1 stated the residents do have access to the backyard. (photographs were taken)

Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 116 degrees F in both resident bathrooms.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2023
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: BETTER LIVING RCH
FACILITY NUMBER: 435202829
VISIT DATE: 12/16/2023
NARRATIVE
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Fire extinguisher was serviced December 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit. LPA requested fire drill log. S1 called ADM. ADM stated the fire drill log is in the locked filing cabinet. S1 stated the ADM is not coming to the facility. LPA called ADM. ADM did not answer LPA's phone call and did not return LPA's phone call.

LPA requested to reviewed facility records 3 residents but the records were incomplete. S1 stated the rest of the records are in the locked filing cabinet. LPA requested to review 3 staff records, but S1 stated he/she does not have access to those records. LPA reviewed 3 resident medications and centrally stored medication records. LPA requested 3 resident P&I records to review. S1 stated he/she does not have access to the P&I funds. LPA asked S1 if the residents wanted to spend their P&I money, how would they do so on weekend. S1 responded he/she does not know and to ask ADM. LPA attempted to call ADM once again but no answer. Staff member in the facility should be able to have access to these documents. LPA conducted interviews with 2 staff (S1 to S2) and 2 residents (R1-R2).

Deficiencies is being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Staff member Shirle Asuncion. LPA attempted to contact ADM to review the report, ADM answered the phone at 5:02pm and stated S1 can read and sign on his/her behalf. Appeal rights were provided.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 12/16/2023 05:10 PM - It Cannot Be Edited


Created By: Manuel Monter On 12/16/2023 at 04:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BETTER LIVING RCH
FACILITY NUMBER: 435202829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on LPA's observation, LPA observed a stack of 3 green chair obstructing the front door of the facility. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2023
Plan of Correction
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ADM will send letter of understanding regarding the regulation and plan of action on how the facility will ensure indoor and outdoor passageways are clear of obstructions. ADM will send by POC date, 12/23/2023.
Type B
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, LPA observed a container of "Comet" cleaning detergent directly outside of the kitchen/dinning area. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2023
Plan of Correction
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ADM will send plan of action on how the facility will keep detergents and cleaning solutions inaccessible to residents in care. ADM will send plan by POC date, 12/23/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Manuel Monter
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 12/16/2023 05:10 PM - It Cannot Be Edited


Created By: Manuel Monter On 12/16/2023 at 04:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BETTER LIVING RCH
FACILITY NUMBER: 435202829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85088(c)(2)
Fixtures, Furniture, Equipment, and Supplies
(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (2) Bedroom furniture including, in addition to (c)(1) above, for each client, a chair, a night stand, and a lamp or lights necessary for reading.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA observation, bedroom's 2 & 3 do not have a chair, night stand or lamp. LPA called ADM, and ADM confirmed that both rooms do not have a night stand or lamps. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2023
Plan of Correction
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ADM stated he/she will send letter of understanding regarding the regulation and a plan of action on how the facility will meet the regulations requirements. ADM stated he/she will send by POC date, 12/23/2023.
Type B
Section Cited
CCR
80066(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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During LPA's visit, LPA requested to review staff records. S1 stated he/she does not have access to the records. LPA called ADM, ADM did not answer the phone. LPA waited for over an hour, but did not receive a call back. LPA was unable to review staff records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2023
Plan of Correction
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ADM stated he/she will send a letter of understanding regarding the regulation and its importance. ADM will send letter by POC date, 12/23/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Manuel Monter
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 12/16/2023 05:10 PM - It Cannot Be Edited


Created By: Manuel Monter On 12/16/2023 at 04:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BETTER LIVING RCH
FACILITY NUMBER: 435202829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80070(d)
Client Records
(d) All client records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA requested to review resident records. S1 stated the he/she only had access to partial resident records. LPA called ADM, but no answer. LPA was unable to fully review resident records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2023
Plan of Correction
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ADM stated he/she will send a letter of understanding regarding the regulation and its importance of having resident records available for licensing agency to review. ADM will send letter by POC date, 12/23/2023.
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA requested to review facility drill records. S1 stated he/she could not find them. S1 called ADM, and ADM stated the records are in the locked cabinet. LPA called ADM, but no answer. LPA was unable to review facility drill log, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2023
Plan of Correction
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ADM will send letter of understanding regarding the regulation. ADM will send letter to LPA by POC date, 12/23/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Manuel Monter
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2023


LIC809 (FAS) - (06/04)
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