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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294258
Report Date: 10/02/2025
Date Signed: 10/02/2025 11:43:46 AM

Document Has Been Signed on 10/02/2025 11:43 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:BECK CARE HOMEFACILITY NUMBER:
435294258
ADMINISTRATOR/
DIRECTOR:		ZHANG, YU & LUO, XI-HUAFACILITY TYPE:
740
ADDRESS:1681 BECK DRIVETELEPHONE:
(408) 866-7858
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY: 6CENSUS: 6DATE:
10/02/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensees Yu Zhang & Xi-Hua LuoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst Manuel Monter and Marcella Tarin conducted a POC case management visit to clear deficiencies cited on September 25, 2025, during an annual inspection visit. LPA also citing the facility an additional deficiency that erroneously not cited during the previous visit.

Clearing pending Plan of Corrections:

The facility was cited the following deficiencies on September 25, 2025 with the following POC dates:
  • 87307 Personal Accommodations and Services (d)(6)- Type A- POC due date September 26, 2025.
  • 87468.2 Additional personal rights of residents in Privately Operated Facilities (a) (4) Type A- POC due date September 26, 2025.
  • 87468.1 Personal Rights of Residents in All Facilities (a)(1)- Type A- POC due date September 26, 2025
  • 87468.1 Personal Rights of Residents in All Facilities (a)(2) – Type A- POC due date September 26, 2025
  • 87463 Reappraisals (a) – Type B- POC due date of October 2, 2025.

During todays visit, LPA's toured the facility side entrance and observed the locked gate no longer had a lock. LPA's requested ADM to review the camera's video footage. ADM provided LPA's access to the cameras and confirmed they are not recording audio.
LPA received plan of corrections by POC date. Deficiencies cleared during todays visit.

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NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: BECK CARE HOME
FACILITY NUMBER: 435294258
VISIT DATE: 10/02/2025
NARRATIVE
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Follow Up, regarding 9/25/2025 annual inspection visit.

During the annual inspection visit, the department inadvertently did not cite an issue that was noted during the end of the annual inspection.

On September 25, 2025, LPA’s Manuel Monter and Marcella Tarin, during the conclusion as of the annual inspection, ADM2 asked if LPA's took photos during todays visit. LPA confirmed due to the current ongoing complaint investigation, LPA's did take photographs of the inside of the shed. ADM2 stated they LPA's cannot do this. ADM2 stated the lease agreement states the shed is not part of the facility. ADM2 stated LPA’s do not have the authority or right to inspect the shed in the backyard or take pictures of the inside of the shed. ADM2 stated if he was there when LPA's took the photos, he would have taken the phones and broken them. LPA told ADM2, the shed is not going to be discussed anymore and that the report needed to be reviewed. ADM2 stated he wanted to see the LPA's delete the photos or he wouldn't review the report or sign the report. LPA Monter told ADM2, the photos will not be deleted. ADM2 stated he refused to sign. ADM1 then attempted to interject, but ADM2 stated, no, and insisted that the photos needed to be deleted.

During todays visit, LPA’s discussed Title 22 regulation, 87755 Inspection Authority of Licensing Agency (a). LPA’s also discussed that the administrator of the facility must collaborate with licensing. LPA’s informed ADM that, due to an open complaint about the backyard shed, the Department will fully investigate the allegation. The LPAs also brought up ADM2’s comment that was made on September 25, 2025 — that he would have broken the LPAs’ state phones if the shed photos were not deleted — noting that it could be construed as a threat or an intimidation attempt.

A deficiency is being cited during todays visit. This report was reviewed with Licensees Yu Zhang & Xi-Hua Luo. A copy of this report and Appeal rights were provided.

Administrator refused to sign. ADM2 stated if the report had anyting to do with the shed, he would refuse to sign.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/02/2025 11:43 AM - It Cannot Be Edited


Created By: Manuel Monter On 10/02/2025 at 09:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/03/2025
Section Cited
CCR
87755(a)

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87755 Inspection Authority of the Licensing Agency (a) Any duly authorized officer, employee ...of the licensing agency may …and inspect the entire premise ...without advance notice.
This requirement was not met as evidence by:
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Licensees/ ADMs stated they will send a letter of understanding regarding the regulation. Licensees/ADM’s stated they will submit a written plan to ensure licensing agency/staff have access to enter and conduct inspection of all areas of the facility, including the shed.
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Based on interviews, ADM2 stated the LPA’s do not have the authority to inspect the shed, & stated he would have taken the phones and broken them, if he was present when the photos were taken. This poses an immediate health, safety, personal rights risks to residents in care.
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Licensees/ ADMs stated they will submit the written Plan of Correction by POC due date October 3, 2025.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Manuel Monter
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2025


LIC809 (FAS) - (06/04)
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