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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294170
Report Date: 12/01/2022
Date Signed: 12/01/2022 03:06:09 PM


Document Has Been Signed on 12/01/2022 03:06 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:CASA PASTEL CARE HOMEFACILITY NUMBER:
435294170
ADMINISTRATOR:ZHAO, PING JINGFACILITY TYPE:
740
ADDRESS:13348 PASTEL LANETELEPHONE:
(650) 961-5368
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:6CENSUS: 6DATE:
12/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Administrator, Lei (Becky) BiTIME COMPLETED:
03:15 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 12/1/2022 at 2:15pm, Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Administrator (ADM), Becky Bi. Administrator Ping Zhao met with LPA Rai and she was present in the facility. ADM Becky stated there are 2 residents under Hospice.

During visit, LPA Rai toured the facility inside. Due to the rain storm, LPA Rai observed the back yard through various patio doors and windows. LPA Rai observed a visitor screening area at the entrance. LPA Rai observed a perishable food supply of 7 days and a non-perishable food supply of 3 days. LPA Rai observed enough PPE supplies. LPA Rai observed 2 out of 2 resident bathrooms, 2 out of 2 guest bathrooms and observed available soap and paper towels. LPA Rai observed COVID-19 related signs throughout the hallways of the facility.

LPA Rai advised Administrator to post up hand washing signs in the resident bathrooms.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Becky Bi 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: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022
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