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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294219
Report Date: 11/12/2021
Date Signed: 11/12/2021 02:19:21 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:2 ALL ABOUT SENIORSFACILITY NUMBER:
435294219
ADMINISTRATOR:KENDALL HALLFACILITY TYPE:
740
ADDRESS:1474 POMPEY DRIVETELEPHONE:
(408) 483-2433
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:6CENSUS: 5DATE:
11/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:DEBRA HALL TIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPA) Christine Dolores conducted an unannounced annual required inspection. LPA met with Debra Hall, Licensee, Annabelle Esperanza, Administrator and Kendall Hall, Administrator.

During today's visit, LPA toured the facility inside and outside to include the central entry point, living room, kitchen, hallways, bedrooms, bathrooms, front patio and backyard.

LPA observed a central entry point and screening area for all visitors and staff. Facility has 6 private resident rooms and 1 staff room.

Bathrooms have supplies of paper towels and soap available for staff, residents, and visitors. Trash cans were observed covered with lid in the bathrooms. LPA observed the following posters, coughing and sneeze etiquette, social distancing, and required mask. Facility disinfect and sanitize high touch surfaces daily and as needed.

Licensee states they have sufficient supply of PPE and PPE supplies are located in another building. LPA advised Licensee to maintain a supply of PPE at the facility.

No deficiencies cited during today's visit per California Code of Regulations, Title 22.

This report was reviewed with Debra Hall, Licensee, Annabelle Esperanza, Administrator and Kendall Hall, Administrator. Copy of this report was provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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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