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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202917
Report Date: 02/08/2024
Date Signed: 02/08/2024 09:25:57 AM

Document Has Been Signed on 02/08/2024 09:25 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:ELLIE REESE CARE HOME LLCFACILITY NUMBER:
435202917
ADMINISTRATOR:OVISO, PORTIAFACILITY TYPE:
735
ADDRESS:3175 SYLVAN DRTELEPHONE:
(408) 891-7016
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 0DATE:
02/08/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Applicant, Portia OvisoTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Simi Rai arrived announced to conduct a follow up visit from facility's pre-licensing visit on 1/18/2024. LPA met with Applicant (AP), Portia Oviso. There are no residents present on site.

During today's visit, LPA Rai inspected the items which unresolved during the pre-licensing visit on 1/18/2024. LPA Rai observed posters including the emergency telephone numbers, personal rights, CCLD compliant poster, complaint information, Rights of Resident Councils, and Personal Rights of Residents in All Facilities. LPA Rai observed an available telephone to use and call the facility number to ensure it was working.
LPA Rai observed 7 days of non-perishable food supply in the pantry area in the garage. LPA Rai observed first aid kit and battery operated flashlight in the medication cabinet in the dining room. LPA Rai observed the light bulb in the Bathroom 2 and hot water pressure in the sink in Bathroom 1 was in good repair. The hot water temperatures in the bathroom sinks measured between 117.1 degrees Fahrenheit and 117.9 degrees Fahrenheit.
LPA Rai toured the outside of the facility and observed gardening tools and chemicals inaccessible to residents. LPA Rai observed the fence in the backyard shared with 3 out of 3 neighbors broken and teared down by the storm over the weekend and last night. AP stated the maintenance team has been informed and they are currently getting supplies to fix the fence today. AP stated once the fence is repaired, she will send a picture of the repaired fence to LPA Rai via email.

Pre-licensing deficiencies have been resolved. Pre-Licensing is now complete.
LPA 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, Portia Oviso and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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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