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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294136
Report Date: 04/17/2023
Date Signed: 04/17/2023 03:22:04 PM

Document Has Been Signed on 04/17/2023 03:22 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:HARMONIE HOMEFACILITY NUMBER:
435294136
ADMINISTRATOR:MORILLO, JULIETFACILITY TYPE:
740
ADDRESS:1463 NESBIT COURTTELEPHONE:
(408) 997-7925
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY: 6CENSUS: 5DATE:
04/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gladys SmartTIME COMPLETED:
03:30 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) Trang Pham and David Marrufo, arrived unannounced to conduct an annual required one year inspection. LPAs met with Gladys Smart, Administrator.

LPAs toured the facility inside and outside including the residents' bedrooms, bathrooms, kitchen, garage and backyard. 5 out of 5 resident bedrooms were observed to have beddings, sheets, functioning lights and sufficient storage space. 2 of the bedrooms were observed to have sliding doors and functioning door alarms. 2 out of 2 resident bathrooms are observed to have grab bars and non-skid mats. Hot water temperature in 2 out of 2 bathrooms was measured at 115 degrees Fahrenheit.

LPAs observed 2 days worth of perishable and 7 days worth of non-perishable food ready for the number of residents at the facility.

LPAs tested facility's smoke detectors and carbon monoxide detectors and all were functional. Fire extinguisher was last serviced on 7/2022.

LPAs observed there was an outdoor pool which was fenced with padlocks and is inaccessible to the residents.Centrally stored medications, toxins, and sharp objects were locked and inaccessible to the residents.LPAs reviewed residents' and staffs' records, which were found to be complete during review.
LPAs reviewed the centrally stored medication log for 5 out of 5 residents and found them to be complete.

During the observation of the outdoor area, LPAs found the handrail in the patio was found to be loose and wobbly. An advisory note was issued, see LIC 9102 for more information.No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Gladys Smart and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2023
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 2