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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202857
Report Date: 02/05/2025
Date Signed: 02/05/2025 04:27:17 PM

Document Has Been Signed on 02/05/2025 04:27 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:DJ'S CAREHOMEFACILITY NUMBER:
435202857
ADMINISTRATOR/
DIRECTOR:
JANET SALVADORFACILITY TYPE:
740
ADDRESS:4318 KINGSPARK DRIVETELEPHONE:
(408) 464-2245
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Janet SalvadorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with administrator (ADM) Janet Salvador. 3 staff and 2 residents were observed in facility.

LPA reviewed 3 resident files and 3 staff files.

LPA toured the facility inside and out with ADM. License, personal right posters, and administrator certificate were observed in the facility. LPA inspected living room, kitchen, dinning area, laundry room and garage. Medication closet, knives closet, and cleaning product closet were observed locked. There are 3 shared resident rooms at the first floor for residents, and 2 restrooms for residents at the first floor. LPA observed 2 resident beds with half bed rails in resident room. ADM provided the doctor orders for resident R1 and R2 to use half bed rails. There are 3 staff live-in rooms, 1 office room, and 1 restroom on the second floor. Room temperature was observed at 72 degree F, and hot water temperature was observed at 115 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The facility has call button system. ADM tested it and the system worked fine.

The facility is equipped with carbon monoxide detectors and fire alarm system. ADM tested the carbon monoxide and fire alarm detectors, and they were working fine. The fire extinguishers were observed on service on 1/14/2025. LPA inspected the backyard, there was no obstruction to block the walkway. The facility conducted fire and emergency drill on 1/18/2025.

First aid box, flash lights and night light were observed in the facility.

No citation noted for today's inspection. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.
Romeo ManzanoTELEPHONE: (408) 277-1289
Chihhsien ChangTELEPHONE: (408) 904-9843
DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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