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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294147
Report Date: 07/27/2021
Date Signed: 07/29/2021 02:03:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:ALL ABOUT SENIORS ELDERLY CAREFACILITY NUMBER:
435294147
ADMINISTRATOR:KENDALL HALLFACILITY TYPE:
740
ADDRESS:1319 MARIA WAYTELEPHONE:
(408) 483-2433
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:6CENSUS: 6DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Kendall HallTIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an unannounced infection control site visit today. LPA met with the Administrator Kendall Hall.

One central entry point was designated for all staff, residents, and visitors. A temperature screening station, sign in sheet, and hand sanitizer were present at the entrance. LPA was temperature checked and was asked to answer a COVID-19 questionnaire to sign in upon entry.

LPA toured the facility. The facility was observed to be in sanitary condition. COVID-19 signs were posted at the entrance, hallways, and throughout the facility. All staff members were observed to be wearing masks.

LPA inspected 2 restrooms. The restrooms observed to be adequately stocked with paper towels and hand soap. Hand washing signs were posted.

Facility was observed to have a good amount of supply of PPE in the storage area. A plan for epidemic outbreak specific to COVID-19 mitigation plan report (LIC 808) was in file. LPA discussed the infection control with the Administrator, suggestions were made. 6 residents and 2 on duty staff were fully vaccinated.

No deficiency cited during visit. However, advisory notes (LIC 9102) were issued.

This report was reviewed with the Administrator. A copy of this report and advisory notes were provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Yatfai NgTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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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