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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202895
Report Date: 11/16/2023
Date Signed: 12/18/2023 10:26:36 AM


Document Has Been Signed on 12/18/2023 10:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814



FACILITY NAME:MORNINGSTAR ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
435202895
ADMINISTRATOR:WELCH, JOYCEFACILITY TYPE:
740
ADDRESS:1380 S DEANZA BLVDTELEPHONE:
(669) 295-6500
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:149CENSUS: 0DATE:
11/16/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Joyce Welch, Phil Altman TIME COMPLETED:
10:27 AM
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
Facility Type: RCFE
Application Type: INTL
Capacity: 149
Census (if any clients in care): 0
COMP II Participants: Joyce Welch administrator, Phil Altman VP Ops
Interview Method:
Virtual interview
On 11/16/23, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing readiness
SUPERVISOR'S NAME: Tracy ThompsonTELEPHONE: (916) 651-7817
LICENSING EVALUATOR NAME: Amy AveryTELEPHONE: (916) 657-2592
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023
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