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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202915
Report Date: 02/13/2024
Date Signed: 02/13/2024 10:02:25 AM

Document Has Been Signed on 02/13/2024 10:02 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:HEART TO HEART ADULT DAY CAREFACILITY NUMBER:
435202915
ADMINISTRATOR:BANWAIT, RUBINAFACILITY TYPE:
775
ADDRESS:450 MARATHON DRIVETELEPHONE:
(408) 460-1791
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 45CENSUS: 0DATE:
02/13/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rubina BanwaitTIME COMPLETED:
10:05 AM
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Licensing Program Analysts (LPAs) Mita Partoza and Simi Rai arrived announced to conduct the facility's pre-licensing visit. LPAs met with Applicant Rubina Banwait and Staff Jeena Dharmakirthi. There are no clients present on site.

During visit, LPAs toured the facility to include the activity rooms, kitchen, storages, bathrooms, and exterior. All fire exit routes were free and clear of obstruction. Toxins observed secured. Facility has an approved fire clearance for 45 non-ambulatory clients.

Bathrooms supplied with hand washing sign, hygiene products, and paper supplies. LPAs observed the carbon monoxide detectors to be in working condition. Hot water temperature maintained between 118.4 - 119.3 degrees Fahrenheit. Facility temperature maintained between 69.4 - 74 degrees Fahrenheit. First aid kit supplied with tweezers, bandages, gauze, scissors, and thermometer. Battery operated flashlights observed on-site. Medications will be stored in a locked cabinet. The facility will lock sharp supplies in a lock box in the office. The following posters observed to include the emergency telephone numbers, personal rights, and facility sketch.

No issues noted during this pre-licensing inspection.

LPAs observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

This report was reviewed with Applicant Rubina Banwait and Staff Jeena Dharmakirthi. A copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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