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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202880
Report Date: 02/28/2025
Date Signed: 02/28/2025 01:27:12 PM

Document Has Been Signed on 02/28/2025 01:27 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:MARCEL'S MEMORY CAREFACILITY NUMBER:
435202880
ADMINISTRATOR/
DIRECTOR:		PENDAR, MARIEFACILITY TYPE:
740
ADDRESS:373 BAY STTELEPHONE:
(480) 578-6785
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 2DATE:
02/28/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Marie Pendar, ADMTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 2/28/2025 - Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced continuation of the required annual inspection and met with the facility administrator (ADM) Marie Pendar. LPA stated the purpose of the visit.

LPA observed, 1 staff (ADM) and 1 resident at the time of the visit.

LPA Partoza, continued with the annual inspection by reviewing staff and resident records, including, centrally stored medication and destruction records (CSMDR) and facility record. Disaster training was done on 2/14/2025.

LPA issued a technical advisory to LIC/ADM for food safety, variation of meals, and protection of the food nutritional values.

During today's visit deficiencies were cited based on the observation on 2/20/25 initial annual inspection per California Code of Regulations (CCR) Title 22. An exit interview was conducted with LIC/ADM Marie Pendar and a copy of the report and appeals rights were provided.

*The licensee have corrected the deficiencies observed by LPA Kenneth Madrigal and Mita Partoza on 2/28/2025.

END OF REPORT
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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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Document Has Been Signed on 02/28/2025 01:27 PM - It Cannot Be Edited


Created By: Maria Partoza On 02/28/2025 at 12:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MARCEL'S MEMORY CARE
FACILITY NUMBER: 435202880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
87465 (h) The following requirements shall apply to medications which are centrally stored:d service. (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation licensee did not comply with the section cited above by not keeping the medicines locked. LPAs observed the medicine drawer was unlocked and easily accessible to persons other than employees responsible for supervision of medication, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2025
Plan of Correction
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On 2/20/25 LIC/ADM stated the magnetic lock will be replaced with a lock that will not easily break. LIC/ADM corrected this deficiency on 2/28/2025 by replacing the magnetic lock.
Type A
Section Cited
CCR
87303(e)(2)
87303 Maintenance and Operation (e)Water supplies and plumbing fixtures shall be maintained ...(2)Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. .... shall be maintained to automatically regulate the temperature of hot water... of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above by not maintaining the hot water temeprature between 105 degree F to 120 degree F. LPAs measured the water temperature 2 times. Water temperature measured at 103.1 degree Farenheit in 2 bathrooms and kitchen, which pose/poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2025
Plan of Correction
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On 2/20/2025, LIC/ADM stated that her maintenance person will need to check the water control system and will correct the deficiency and monitor the water temperature to measure between 105 degree Fahrenheit to 120 degree Fahrenheit. On 2/28/2025 - LIC/ADM have corrected this deficiency and water temperature measured at 107 degree Fahrenheit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Maria Partoza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/28/2025 01:27 PM - It Cannot Be Edited


Created By: Maria Partoza On 02/28/2025 at 12:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MARCEL'S MEMORY CARE
FACILITY NUMBER: 435202880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
87309 Physical Plant/Environmental Safety (a) Except as specified in subsection (b), the licensee shall ensure that ...knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage ... This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above by not locking sharps/knives inside the kitchen drawer and can be easily accessed by persons in care which pose/poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2025
Plan of Correction
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On LIC/ADM stated that the magnetic locking mechanism of the drawers will be replaced. On 2/28/2025, LIC/ADM corrected this deficiency and placed a padlock on the drawer.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Maria Partoza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
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