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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202897
Report Date: 06/02/2023
Date Signed: 06/02/2023 12:59:12 PM


Document Has Been Signed on 06/02/2023 12:59 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:FAMILY FEELS RESIDENTIAL CAREFACILITY NUMBER:
435202897
ADMINISTRATOR:SHIH, YIWENFACILITY TYPE:
740
ADDRESS:781 TERRAZO DRTELEPHONE:
(408) 224-6225
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:6CENSUS: 5DATE:
06/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nicole ShihTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Pre-Licensing visit and met with Nicole Shih, co-licensee.

During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo toured the kitchen area and observed there to be a perishable food supply of two days and a non-perishable food supply of at least seven days. LPA Marrufo observed medications to be stored in a locked cabinet. Cleaning supplies and sharps were stored in a locked cabinet. The first aid kit was inspected and found to be complete.

LPA Marrufo toured 5 out of 5 resident bedrooms. Each bedroom had a bed with bedding, dresser and clothing storage areas, and functioning lighting. The smoke detectors and carbon monoxide detector were tested and found to be functional.

LPA Marrufo toured 1 out of 1 resident bathrooms and found it to have available soap and paper towels. The water temperature measured at 124 F.

The outdoor areas were observed and the outdoor exits were found to be clear of obstructions.

LPA Marrufo reviewed the resident and staff records and found them to be complete.

LPA Marrufo reviewed COMPONENT III presentation with Nicole Shih, Thuc Oanh Trinh, and Rita Garcia.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

LPA Marrufo reviewed this report with Nicole Shih and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023
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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