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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294219
Report Date: 11/06/2024
Date Signed: 11/07/2024 11:19:15 AM

Document Has Been Signed on 11/07/2024 11:19 AM - 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:2 ALL ABOUT SENIORSFACILITY NUMBER:
435294219
ADMINISTRATOR/
DIRECTOR:
KENDALL HALLFACILITY TYPE:
740
ADDRESS:1474 POMPEY DRIVETELEPHONE:
(408) 483-2433
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Annabelle EsperanzaTIME VISIT/
INSPECTION COMPLETED:
03:10 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 (LPA) Christine Dolores and Santino Fortes conducted an unannounced annual inspection, and met with Administrator Annabelle Esperanza and Licensee Kendall Hall. ADM informed that facility has 2 staff and 6 clients.

LPAs toured the facility inside out including: kitchen, living room, family room and 1 staff room, 6 resident rooms and 2 restrooms. LPAs observed a non-operational security camera in the living room area. LPAs observed Full Bed rails for resident (R1) and confirmed Physicians order for Full Bed rails. In R1 room LPAs observed a fall detection camera that was not currently in use and consent form for use of camera was in the resident's file. Restrooms observed to have non slid flooring. LPAs observed perishable food supply of at least two days and non-perishable food supply of at least seven days. Refrigerator temperature was observed at 45 degrees F and Freezer temperature was initially observed at 22 Degrees F. Licensee adjusted freezer temp and 0 degrees F was observed. The front yard and backyard of the facility was also inspected. There was no obstruction to block the outdoor exits. Garage was observed to be locked and used as storage. LPA observed Facility License and Resident Personal rights were posted. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. Room temperature was at 73 degree F, and hot water temperature was initially measured 136F from kitchen. After adjustment kitchen water temperature was observed to be 113F. LPA inspected the facility first aid kit and it was observed to be complete. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors and carbon monoxide detectors functioned properly when tested. Fire extinguishers were last serviced on 12/1/23 . The facility conducted their last fire drill on 10/29/24.

LPA reviewed facility records for 3 staff and 3 clients to be complete. LPA reviewed 3 clients medications and centrally stored medication records and observed to be complete.

No deficiencies were cited during today's visit as per California Code of Regulations Title 22. Exit interview was conducted with ADM and Licensee. This report was reviewed and a copy was provided to ADM for signature.

Jackie JinTELEPHONE: (714) 319-3786
Santino FortesTELEPHONE: (818) 378-8120
DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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