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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202830
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:48:29 PM

Document Has Been Signed on 10/12/2022 01:48 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:AEGIS CARE, INC.FACILITY NUMBER:
435202830
ADMINISTRATOR:GHARAKHANIAN, CANDICEFACILITY TYPE:
735
ADDRESS:1060 ORTEGA CIRTELEPHONE:
(408) 461-0330
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 6CENSUS: 5DATE:
10/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:GHARAKHANIAN, CANDICETIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Licensee, Candice Gharakhanian.

During visit, LPA toured the facility to include the living room, kitchen, dining room, resident rooms, bathrooms, garage, and backyard. All fire exit routes were free and clear of obstruction. All staff present observed wearing a mask and are fingerprint cleared.

Facility has a designated entry point for symptom screening and temperature check for all visitors, staff, and clients. Visitor guidelines posted at the front door. Hand sanitizer made available at entry and throughout the facility. Bathroom supplied with paper supplies, hygiene products, and hand washing sign. LPA observed facility's Personal Protective Equipment (PPE) supplies. Staff are trained on infection control. LPA reviewed the facility's procedures to isolation and visitation. Facility staff are working on getting N95 fit tested. The following posters observed to include hand washing sign, symptoms of COVID, and stop the spread of germs.

No deficiencies were cited per California Code of Regulations, Title 22. Advisory notes provided.

This report was reviewed with Candice Gharakhanian and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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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