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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202837
Report Date: 03/13/2025
Date Signed: 03/13/2025 04:15:13 PM

Document Has Been Signed on 03/13/2025 04:15 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:NIJJAR HOMEFACILITY NUMBER:
435202837
ADMINISTRATOR/
DIRECTOR:
NIJJAR, MANJINDER K.FACILITY TYPE:
735
ADDRESS:3661 CADWALLADER AVETELEPHONE:
(408) 341-5254
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 6CENSUS: 4DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Manjinder K. Nijjar, ADMTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On March 13, 2025, at 2:15 PM, Licensing Program Analyst (LPA) Kenneth Madrigal and Manuel Monter conducted an unannounced annual inspection visit, and met with Amarvir Nijjar, ADM. Upon arrival, Staff 1 (S1) identified themselves and LPAs were granted access to the facility as LPAs explained the purpose of the visit.

During the entrance of the inspection, LPAs observed 3 residents and 1 staff. LPA toured the facility inside and out with the manager which included the living room, kitchen, dining room, two restrooms, and four residents’ bedrooms. The front yard and backyard were inspected. Two-day perishable food supplies and seven-day nonperishable food supplies were observed. LPA observed the cleaning product and knife storage areas are locked and inaccessible to residents in care. Room temperature was at 68 degrees F, and hot water temperature was measured at 110 degrees F in bathrooms. In the hallway, there are two holes (photographs taken by LPAs), Manager stated that it was caused by one of the resident’s behaviors and will patch the walls by this weekend. Manager stated he would send LPA’s photo documentation showing the holes have been patched.

Fire extinguisher was last serviced on November 4, 2024. The facility was equipped with smoke and carbon monoxide detectors and were tested by LPAs and ADM. LPAs inspected the facility first aid kit and reviewed the facility fire/earthquake drill log. The facility's last drill was on January 11, 2025.

LPAs reviewed 4 resident medical and non-medical records and 4 staff facility records. LPAs conducted three resident interviews and one staff interview.

No Deficiencies cited during today’s visit based on LPA observations, interviews conducted and record reviews in accordance with the California Code of Regulations (CCR) Title 22. This Evaluation Report was reviewed with Amarvir Nijjar, Administrator and a copy of the signed report was provided to her.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Kenneth Madrigal
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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