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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202930
Report Date: 07/09/2024
Date Signed: 07/09/2024 10:27:01 AM

Document Has Been Signed on 07/09/2024 10:27 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:SHIRAN 2 CARE MANAGEMENT INC.FACILITY NUMBER:
435202930
ADMINISTRATOR/
DIRECTOR:		URENA, AIDAFACILITY TYPE:
735
ADDRESS:821 ESCHENBURG DRTELEPHONE:
(408) 649-8537
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 6CENSUS: 0DATE:
07/09/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Iman Tootoonchi and Aida Urena TIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived announced to conduct the pre-licensing inspection. LPA met with Iman Tootoonchi and Aida Urena.

There are no residents in care. Facility has an approved fire clearance for 6 ambulatory.
LPA toured the facility to include the kitchen, dining room, living room, 3 resident shared bedrooms, 2 bathrooms, garage, office, and backyard.

LPA observed 1 shed in the backyard which includes 2 rooms. The backyard shed is intended for storage or an activities space.

All fire exit routes are free and clear of obstruction. Facility has fire extinguishers, carbon monoxide detectors, and an operable thermostat present.

Kitchen observed with cups, plates, bowls, utensils, and cooking supplies. Lidded trash bin observed in the kitchen. Locks observed on the cabinets for the chemicals/disinfectants, medications, and records. Refrigerator temperature maintained at 28 degrees Fahrenheit. Freezer temperature maintained below 0 degrees Fahrenheit.

Dining room observed with a table and chairs. Activities observed in the dining area. Fire space observed screened in the living room. Living room is equipped with seating.

3 out of 3 resident bedrooms supplies with beds, linens, night stands, dresser, ceiling light, and lamps. 2 out of 2 bathrooms shower contains non-slid mats and grab bars. Bathroom hot water temperature maintained at 110 degrees Fahrenheit.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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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: SHIRAN 2 CARE MANAGEMENT INC.
FACILITY NUMBER: 435202930
VISIT DATE: 07/09/2024
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Emergency disaster plan observed posted at the entrance. LPA observed the emergency supplies to include flashlights, batteries, non-perishable foods, and 2 emergency backyard which includes first aid kits.

Posters observed at the entrance to include but not limited to if you see something say something, house rules, personal rights, visitation policy, and grievance.

Comp III reviewed with Iman and Aida.

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 Iman Tootoonchi and Aida Urena and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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