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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294219
Report Date: 11/22/2022
Date Signed: 11/22/2022 10:46:09 AM


Document Has Been Signed on 11/22/2022 10:46 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:KENDALL HALLFACILITY TYPE:
740
ADDRESS:1474 POMPEY DRIVETELEPHONE:
(408) 483-2433
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:6CENSUS: 6DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:KENDALL HALLTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual focusing on infection control. LPA met with Administrators, Annabelle Esperanza and Kendall Hall.

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. Facility temperature maintained at 74 degrees Fahrenheit. All fire exit routes were free and clear of obstruction. All staff observed wearing a face mask.

Facility has a designated entry point point for symptom screening and temperature check for all visitors and staff. Hand sanitizer available at entry. Bathrooms supplied with paper supplies, hygiene products, and hand washing sign. Facility staff clean and disinfect multiple times daily and as needed. LPA observed facility's Personal Protective Equipment (PPE) supplies and lidded trash can. Facility staff are trained on infection control. Staff are not N95 fit tested. LPA reviewed facility's procedures to visitation. LPA observed the following posters, coughing and sneeze etiquette, social distancing, required mask, and hand washing.

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

This report was reviewed with Administrator, Annabelle Esperanza and Kendall Hall and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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