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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202853
Report Date: 02/20/2024
Date Signed: 09/30/2024 04:42:44 PM

Document Has Been Signed on 09/30/2024 04:42 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 HOME #2FACILITY NUMBER:
435202853
ADMINISTRATOR:GONZALEZ, DORISFACILITY TYPE:
735
ADDRESS:6047 SAN YSABEL WAYTELEPHONE:
(408) 592-5303
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 4DATE:
02/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:41 PM
MET WITH:Dors Gonzalez and Esther KattanTIME COMPLETED:
07:15 PM
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Licensing Program Analysts (LPAs) Steve Chang and Maria (Mita) Partoza conducted an unannounced case management and met with administrator (ADM) Doris Gonzalez and House Manager (HM) Esther Kattan.

The purpose of the case management is to address the following observations from 12/29/2022.
Infection control plan, smoke detector and 911 protocol.

LPAs asked if there is an infection control plan in place for people with Covid 19. HM stated that resident needs to isolate right away and will require staff and resident to wear a mask and follow their infection control plan. HM stated some residents (R1 to R2) share a room and 2 of the resident have their own room R3 to R4. When one of the residents tested positive for Covid, they use part of the living room space as temporary isolation area and close the curtain. HM stated that R1s roommate is mostly out of the facility and stays with his/her partner about 3 times out of the week. R1s roommate was not in the facility during today's visit. HM stated that visitors are asked COVID 19 symptom health checks and takes their temperature prior to entering the facility

LPAs checked the smoke alarm and observed that they are in good working condition and no beeping sound for low battery.

LPA asked HM the facility's protocol for calling 911. HM stated that the staff knows when to call 911. HM stated 911 is called for emergencies, such as but not limited to altercations between residents and when a resident fell and hurt themselves because of seizure.

No deficiencies were cited per CCR Title 22 during today's case management visit. A copy of this report was provided to Administrator Doris Gonzalez and House Manager Esther Kattan.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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