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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202897
Report Date: 11/06/2025
Date Signed: 11/06/2025 05:14:42 PM

Document Has Been Signed on 11/06/2025 05:14 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/
DIRECTOR:		SHIH, YIWENFACILITY TYPE:
740
ADDRESS:781 TERRAZO DRTELEPHONE:
(408) 300-1757
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 6CENSUS: 5DATE:
11/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:25 PM
MET WITH:Administrator Rita GarciaTIME VISIT/
INSPECTION COMPLETED:
05:25 PM
NARRATIVE
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Licensing Program Analyst Manuel Monter conducted a case management deficiencies visit was conducted due to violations discovered during the investigation process and safety check for residents in care. LPA met with Administrator Rita Garcia (ADM2). LPA explained the purpose of the visit.

Due to comments made by staff during the complaint investigation, regarding delayed payments to staff, LPA also followed up regarding the facility's finances. LPA spoke with ADM Yiwen. ADM Yiwen stated the facility is not in financial distress. ADM Yiwen stated there was a time in May when staff's paychecks were delayed due to an issue with the bank. ADM Yiwen stated that issue was resolved with in 3 days.

During visit, LPA toured the facility kitchen. LPA observed Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA also observed toiletry supplies. LPA also observed 3 staff in the facility and 5 residents.

Wile investigating the complaint 26-AS-20250609082231, regarding R1, LPA noted issues in resident R1's appraisal needs and services plan, dated August 1, 2023. LPA asked ADM2 if she has an updated Needs and services plan for R1. ADM2 stated the appraisal needs and service plan dated August 1, 2023 is the only needs and services plan they have on file.

The Department reviewed resident R1’s Physician's Report dated August 18, 2023. R1's physician's report is not signed by the physician. LPA asked ADM2 if she had a signed copy. ADM2 stated the physicians report on file was the only one the facility had. Page 1 Out of 2.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/06/2025 05:14 PM - It Cannot Be Edited


Created By: Manuel Monter On 11/06/2025 at 03:57 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: FAMILY FEELS RESIDENTIAL CARE
FACILITY NUMBER: 435202897

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2025
Section Cited
CCR
87458(a)

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87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional...
This requirement was not met as evidenced by;
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ADM2 stated she will send a letter of understanding regarding the regulation. ADM2 stated she shall obtain a new physician's report for R1 and send CCL a copy of the physician's report by POC due date, November 13, 2025.
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Based on record review and interview; R1’s Physician's Report dated 8/18/23. R1's physician's report is not signed by the physician. ADM2 stated that physicians report on file was the only one the facility had. This poses a potential threat to residents health, safety and personal rights.
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Type B
11/06/2025
Section Cited
CCR87463(a)

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87463 Reappraisals (a)The pre-Admission appraisal... shall be updated in writing as frequently as necessary or once every 12 months ... to keep the appraisal accurate...
This requirement was not met as evidenced by;
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ADM2 stated she will send a letter of understanding regarding the regulation. ADM2 stated she will send LPA an updated appraisal needs and service plan for R1 by November 13, 2025.
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Based on record review and interview, ADM2 stated the appraisal needs and service plan dated August 1, 2023 is the only needs and services plan they have on file. This poses a potential threat to residents health, safety and personal rights.
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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.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Manuel Monter
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 435202897
VISIT DATE: 11/06/2025
NARRATIVE
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LPA provided the Licensees information regarding the Department’s technical support program (TSP) and provided TSP Brochure and Community Care Licensing Division (CCLD) website www.cdss.ca.gov

Deficiencies was cited during todays visit. This report was reviewed with Administrator Rita Garcia. Appeal rights were provided.

Page 2 Out of 2. END OF REPORT.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
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