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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202852
Report Date: 05/05/2023
Date Signed: 05/05/2023 01:52:53 PM

Document Has Been Signed on 05/05/2023 01:52 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:EMANUEL'S CARE HOMEFACILITY NUMBER:
435202852
ADMINISTRATOR:GONZALEZ, DORISFACILITY TYPE:
735
ADDRESS:2053 RADIO AVETELEPHONE:
(408) 592-5303
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 6CENSUS: 5DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Administrator Doris GonzalezTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA)Manuel Monter and Licensing Program Manager Romeo Manzano conducted an unannounced Required 1 Year visit and met with Administrator (ADM), Doris Gonzalez and Manager, Esther Kattan.

LPAs toured the facility inside and out. LPAs toured the facility in the following area: resident/staff bedrooms, kitchen, hallway free from obstructions, living and dining area. Food supplies were also inspected for both 7 days non-perishable and 2 days perishables. Facility first aid kit was observed and met the requirement. Toxic materials and sharp or hazardous objects were observed inaccessible to residents in care. The facility had toiletries. There are two bathrooms/shower with grab bars and skid mats/shower chair. The facility hot water temperatures in the following areas are measured with thermometer. The temperature varies from 110 to 156 (woman's bathroom) degrees F.

The facility fire extinguisher was also inspected. Administrator stated bought new fire extinguisher dated 03/30/2023, receipt was provided and will be installed today. During inspection of the facility laundry area, LPA did not observe a dryer. LPA observed clothes lines for residents clothing.

Facility smoke detectors including carbon monoxides were observed and tested and found to be functioning. The facility yard was inspected and no tripping hazards or hazardous items observed during inspection.

During inspection of the facility, the separate housing unit located at the back of the facility across the storage separated by a fence/gate is now being rented by 1 individual. Per the facility floor plan on record, this separate housing used to be staff housing. ADM/licensee to submit a updated floor plan to CCLD on 5/8/23. LPA also discussed to ensure that the individual (renter) has to be fingerprinted and no access to the facility and residents in care.
Page 1 out 2, See 809-c
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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 2
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: EMANUEL'S CARE HOME
FACILITY NUMBER: 435202852
VISIT DATE: 05/05/2023
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LPA reviewed facility records for staff and residents. LPA reviewed resident medications and centrally stored medication records. LPA conducted interviews with 3 staff (S1 to S3). 5 Out 5 residents were attending day program during visit and were not interviewed. LPAs also inspected 3 Out 5 residents P and I.
During today's inspection Technical Violation (TV) were issued. See LIC9102.

This report was reviewed with Administrator Doris Gonzalez, House Manager Esther Kattan, and staff Israel Gonzalez. A copy of this report was provided during exit interview.

End of report.

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

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
LIC809 (FAS) - (06/04)
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