435202968-10-10-2025-26-AS-MMOR-DMBRZB-20251010132739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202968
Report Date: 10/10/2025
Date Signed: 10/10/2025 01:27:46 PM

Document Has Been Signed on 10/10/2025 01:27 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:	OAK CANYON LIVING		FACILITY NUMBER:	435202968
ADMINISTRATOR/ DIRECTOR:	SCHOFIELD, DEWANNE		FACILITY TYPE:	740
ADDRESS:	1506 TORRE CT		TELEPHONE:	(408) 304-8466
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95120
CAPACITY: 6		CENSUS: 0	DATE:	10/10/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:50 AM
MET WITH:	Licensee Jerica Gonzales and Administrator Dewanne Schofield		TIME VISIT/ INSPECTION COMPLETED:	01:35 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	On October 10, 2025, Licensing Program Analyst (LPA) Manuel Monter, conducted an announced pre-licensing inspection and met with Licensee (LN) Jerica Gonzales and Administrator Dewanne Schofield. The facility is a residential care facility for the Elderly (RCFE). The facility fire clearance is approved for 5 non ambulatory and 1 bedridden. At the time of inspection there are 0 clients observed. LPA and LN toured the facility inside and outside, which included the Living room, kitchen, dining room, two restrooms and three residents bedrooms. The front yard and backyard were inspected. There was no obstruction to block the walkways. LPA observed a jacuzzi located in the side yard adjacent to the family room and 3 care garage. LPA observed facility garage being used as a storage space. LN provided update facility sketch reflecting the hot tube, which is located adjacent to the family room and 3 care garage. LPA toured bedroom #1. LPA observed bedroom #1 has an exit to the backyard, which contains a ramp. LPA also observed bedroom #1's bathroom, has a door exiting to the outdoor patio. LN stated the door exiting to the outdoor patio is not a designated exit. The facility has 3 designated exit routes per LIC 610D (emergency and disaster plan). The exits are free from obstruction. The facility has carbon monoxide and smoke alarm detectors that are strategically placed throughout the building. The facility fire extinguishers are placed strategically in the dinning room. The fire extinguishers were serviced on January 27, 2025. Page 1 Out of 2.

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

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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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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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: OAK CANYON LIVING	FACILITY NUMBER: 435202968
	VISIT DATE: 10/10/2025

NARRATIVE

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The laundry area is located adjacent to bedroom 3 and bathroom 2. The laundry detergents, cleaning supplies and other toxic are locked and can only be accessed by staff.

3 Out of 3 resident bedrooms have adequate lighting, bed frames with mattress, linens, lamps, night stands, drawer dresser storage and closet space that is sufficient to store clients’ personal belongings.

2 Out of 2 bathrooms hot water temperature measured at 118 degrees Fahrenheit. Room temperature is at 76 degree F.

Medication closet observed to be locked. First Aid kit was observed inside the medication cabinet, which contained first aid supplies, with manual, tweezers and scissor. Facility kitchen equipment is functioning properly, LPA observed for sharps. LPA reviewed emergency disaster plan and confirmed its completeness. LPA observed cleaning products and chemicals locked an inaccessible to residents in care. Facility bulletin board contain all necessary documents. No issues noted during this Pre-Licensing Inspection.

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.

Component III orientation was conducted with Licensee Jerica Gonzales and Administrator Dewanne Schofield. This report was reviewed with Licensee Jerica Gonzales and Administrator Dewanne Schofield and a copy of the report was 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: 10/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

LIC809 (FAS) - (06/04)

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