<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202853
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:52:58 PM

Document Has Been Signed on 09/30/2024 02:52 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 HOME #2FACILITY NUMBER:
435202853
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, DORISFACILITY TYPE:
735
ADDRESS:6047 SAN YSABEL WAYTELEPHONE:
(408) 592-5303
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 4DATE:
09/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Doriz Gonzalez - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection visit and met with licensee/administrators (LIC/ADM) Doris Gonzalez and Esther Kattan and stated the purpose of the visit. The facility is licensed to serve adults 18 to 59 approved for 6 ambulatory of which 2 may be non-ambulatory.

At 1:15 pm, LPA toured the facility inside and outside with staff including but not limited to the kitchen, bathroom, dining room, living room, 4 residents rooms, garage, backyard and exterior walkways. The temperature inside the home was at 75 degrees Fahrenheit.

The facility is maintained, sanitary and organized. Knives and sharps were locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. The water temperature measured at 106 to 109.7 degrees Fahrenheit. The bathroom/s are equipped with grab bars and non-skid mats. Resident's room were observed to have sufficient storage, sanitary and organized. The backyard, walkways, ramps are free from debris and obstruction. Laundry soap and cleaning supplies are locked and not accessible to residents in care. Medications are kept locked and inaccessible to residents. The first aid kit is complete and accessible to staff. The facility is equipped with a fire, smoke and carbon monoxide alert system that is in good working condition.

LPA reviewed 2 resident records, the centrally stored medication and destruction record (CSMDR), admission agreement, needs and services plan, health screening and observed records to be complete . LPA reviewed 2 staff records, required training, first aid/CPR training, health screening and background clearance. All staff have criminal record clearance/fingerprints and records were complete. Fire and earthquake drill was last administered on 7/24/2024.

No deficiencies were cited during today's visit. An exit interview was conducted with licensee/administrators (LIC/ADM) Doris Gonzalez and Esther Kattan. A copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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 1