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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202831
Report Date: 09/09/2021
Date Signed: 09/09/2021 01:03:47 PM

Document Has Been Signed on 09/09/2021 01:03 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:EUPHORIA CARE, INC.FACILITY NUMBER:
435202831
ADMINISTRATOR:GHARAKHANIAN, CANDICEFACILITY TYPE:
735
ADDRESS:9061 WREN AVETELEPHONE:
(408) 848-8116
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 6CENSUS: 6DATE:
09/09/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Candice GharakhanianTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Prelicensing visit and met with Candice Gharakhanian.

During visit, LPA toured inside and outside of the facility. LPA observed the kitchen area and staff opened each drawer and the refrigerator for LPA to observe. LPA observed 3 out of 3 resident bedrooms and observed each bedroom had working lights, beds with sheets, and dressers. LPA observed 2 out of 2 resident bathrooms and observed water temperature to be 111 F. LPA observed there to be a visitor screening station at the facility entrance and COVID-19 related posters throughout the facility.

LPA tested the smoke detectors in the bedrooms and hallways and found them to be functional. LPA tested the carbon dioxide detector and found it to be functional. LPA reviewed the first aid kit and found it to be complete. LPA observed the outdoor area and found the exit was clear of obstruction. LPA observed the fire extinguisher in the kitchen and found the service tag had a date of October 2020.

LPA reviewed resident and staff records, Personal & Incidental Monies Log, and Centrally Stored Medication Log for all residents and found them to be complete. LPA reviewed the emergency disaster drill log and observed that drills were conducted at least once a quarter.

LPA Marrufo reviewed Component III presentation with Administrator Candice Gharakhanian during visit. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Candice Gharakhanian and a copy of this report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2021
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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