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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
435202858
Report Date:
10/19/2022
Date Signed:
10/19/2022 04:51:55 PM
Document Has Been Signed on
10/19/2022 04:51 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
CCLD Regional Office
,
2580 N. FIRST STREET, STE. 350
SAN JOSE
,
CA
95131
FACILITY NAME:
SENIOR SWEET CARE HOME
FACILITY NUMBER:
435202858
ADMINISTRATOR:
CHOW, MADELINE
FACILITY TYPE:
740
ADDRESS:
251 DELIA STREET
TELEPHONE:
(408) 649-3202
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95127
CAPACITY:
6
CENSUS:
4
DATE:
10/19/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:35 AM
MET WITH:
Xiuyan Chen
TIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPAs) Steve Chang and Simi Rai conducted an unannounced inspection visit and met with Administrator (ADM) Xiuyan Chen. LPA addressed the purpose of today's visit to ADM.
LPAs toured the facility inside out with ADM. Two staff and 4 residents were observed.
The facility was observed under normal operational condition.
No citation were noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature.
SUPERVISOR'S NAME:
Romeo Manzano
TELEPHONE:
(408) 324-2112
LICENSING EVALUATOR NAME:
Chihhsien Chang
TELEPHONE:
(408) 904-9843
LICENSING EVALUATOR SIGNATURE:
DATE:
10/19/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/19/2022
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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