<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202941
Report Date: 09/06/2024
Date Signed: 09/06/2024 12:45:23 PM


Document Has Been Signed on 09/06/2024 12:45 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:EKAM CARE HOMEFACILITY NUMBER:
435202941
ADMINISTRATOR:KAUR, BHUPINDERFACILITY TYPE:
740
ADDRESS:2536 AUSTIN PLACETELEPHONE:
(408) 249-1149
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:6CENSUS: 5DATE:
09/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Applicant Kaur, BhupinderTIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez conducted a unannounced pre-licensing inspection for a change of ownership. LPAs met with Applicant, Bhupinder Kaur. The home currently has 5 residents. The facility is approved for Fire Clearance for 6 Non-Ambulatory residents.

LPAs toured the facility inside and out. The facility is equipped with smoke and carbon monoxide detectors in working condition. Fire extinguisher observed in the home which were all serviced on 10/25/2023. The kitchen, dining and living room were observed in good repair.

Resident bedrooms were observed in good repair, furnished, with clean linens and adequate lighting. Bathrooms were observed clean and equipped with grab bars. The water temperature range for facility bathrooms were 108 - 108.7 degrees F. The water temperature in the kitchen was measured at 106.6 degrees F. Centrally stored medication cabinet with first aid kit was observed locked. 2-day perishable and 7-day non-perishable food were observed in the kitchen. All outdoor and indoor passageways were observed clear and free of obstruction. The backyard was inspected, no bodies of water observed. LPAs observed laundry room and it is not being used as living quarters.

Component III orientation was completed with applicant.

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, Bhupinder Kaur and a copy of the report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit RaiTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024
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 1