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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294256
Report Date: 07/26/2021
Date Signed: 07/26/2021 03:54:54 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:EASTRIDGE RESIDENTIAL CARE HOMEFACILITY NUMBER:
435294256
ADMINISTRATOR:MARY ROSE BAQUIRANFACILITY TYPE:
740
ADDRESS:2690 KEPPLER DRIVETELEPHONE:
(408) 799-0502
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY:6CENSUS: 5DATE:
07/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Mary Rose BaquiranTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Gladys Kuizon conducted an annual inspection today and met with Administrator Mary Rose Baquiran.

At 1:20 PM, LPA entered the facility through the facility's central entry point and was screened by staff. At 1:26 PM, a tour of the facility was conducted. COVID-19 postings were observed throughout the facility including bathrooms, living room, dining room, and kitchen. 5 residents and 3 staff were present during visit. Staff were observed wearing face coverings while attending to residents. The facility's room temperature is 78 F.

Hand sanitizers, soap, and paper supplies were observed available. At least 2 days' supply of perishable food and at least 1 week's supply on non-perishable food supply was observed in the premises. Personal protective equipment (PPE) and disinfection supplies were available in the premises.

Per Administrator, all residents and staff are fully vaccinated against COVID-19. The facility is currently accepting visitors inside the facility. The facility's mitigation plan was received and reviewed by Community Care Licensing Division.

Exit routes were observed clear and unobstructed. The facility is equipped with smoke detectors, fire extinguishers, and carbon monoxide detectors. A current roster of residents with emergency contact information was reviewed.

No deficiencies were cited. Exit interview conducted with Administrator and a copy of this report was provided during visit.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys KuizonTELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
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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