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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294258
Report Date: 09/25/2025
Date Signed: 09/25/2025 05:13:49 PM

Document Has Been Signed on 09/25/2025 05:13 PM - 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:
09/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Administrator Xi-Hua LuoTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit and met with Administrator Xi-Hua Luo. During the visit, LPA observed 6 residents and 3 staff. LPA explained the purpose of the visit was to conduct the annual inspection, continue the complaint investigation for the complaint 26-AS-20250115102820 and follow up on an incident report regarding an elopement.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 5 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. While touring the side of the facility, adjacent to the kitchen/ family room, LPA observed the side gate had a lock, obstructing the side exit. (Photograph of the lock gate was taken.) ADM stated the gate is locked because resident R1 has wandering behaviors.

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 79 degrees F, and hot water temperature was measured at 106.7 degrees F to 113 degrees F in resident bathrooms.

Fire extinguisher was serviced in July 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on 8/26/2025.. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed facility records for 3 staff and 3 residents. Based on a review, resident R1's needs and services plan has not been updated, and does not address R1's wandering behavior. Page 1 Out of 3.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2025
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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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: 09/25/2025
NARRATIVE
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While touring the home, LPA's observed resident R2 seated in a wheel chair in front of the dinning room. LPA's then noted resident's wheel chair was tied to the dinning table. (Photograph was taken.) LPA's asked staff S1 why R2 was tied. S1 stated R2 will sit on his/her wheel chair alongside the dinning room table and push him/herself. S1 stated she doesn't know since when R2 was being tied. S1 stated R2 isn't being tied everyday. Staff S2 stated the ADM, S1, S3 and him/herself has been tying R2 to the table since the past 2 weeks. S2 stated they tied R2 because he/she pushes him/herself against the dinning room table, which almost causes R2 to fall. Staff S3 stated the care givers on shift, including him/herself has been tying R2 when he/she is sitting at the dinning room table. S3 stated the tying has been occurring for over a month. ADM stated R2 has been pushing him/herself against the table the past week. ADM stated he/she doesn't know since when R2 has been tied. LPA asked ADM if she has ever tied R2, ADM stated

During the tour of the facility, LPA's noted facility cameras throughout the facility. LPAs asked ADM if the cameras record with audio. ADM stated confirmed the cameras inside the facility do record with audio. LPA asked ADM how often she checks the video cameras. ADM stated she checks everyday.

Incident Report, dated September 19, 2025

On September 19, 2025, the Department received an incident Report regarding resident R1. The incident Report stated, on September 16, 2025, at 3:00pm, R1 had episode of wandering out of the facility. Staff checked on R1 around 2:30pm and R1 was asleep in bed. Around 3:00pm, staff went to R1’s room and couldn’t find him/her. Staff checked all inside and outside of facility, but R1 wasn’t found. The facility has camera around all exit doors and R1 wandered out from side yard gate. All exit door have alarms. The alarm was working when R1 exited, but staff did not check the alarm. Staff had searched all neighborhood, still could not find R1. Staff received call from EMT stating they received a call from people walking in the street regarding R1. R1 sent to hospital.

On September 19, 2025 LPA Partoza interviewed staff S1. S1 stated R1 has a wandering behavior and they have an alarm on all the doors. S1 stated that at 2:30 p.m. R1’s Family member (FM) came and asked for R1. FM stated that R1 was not in the room, S1, proceeded to go look for R1 inside the facility. S1 stated when he/she went outside at the backyard, he/she saw the backyard gate open.
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NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC809 (FAS) - (06/04)
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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: 09/25/2025
NARRATIVE
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On September 19, 2025, LPA Partoza interviewed Administrator Julia Zhang. ADM stated that R1 has a wandering behavior and likes to walk around the house and the backyard.

ADM stated they keep a latch on the backyard gate, but at 2:00 p.m. another resident was dropped off by a driver from a transportation provider. The resident came from his/her dialysis appointment and went through the side gate. The side gate was left open by the driver and did not close the gate.

ADM stated that's what she was told by the staff. ADM stated that a neighbor saw R1 and called the ambulance. ADM stated he/she received a call from the EMT. ADM stated that EMT called the care facilities in the neighborhood and used the CCLD website and contacted the facilities around the neighborhood.

ADM stated usually R1 doesn’t leave the facility, this was the first time this happened after being at the facility for 10 months. R1 was brought to Good Samaritan Hospital and was released back to the facility.

On September 25, 2025, LPA Monter interviewed ADM. ADM stated she was informed about R1's elopement around 3:29pm. ADM stated she was near the facility and when she arrived, she searched for R1. ADM stated at 3:45pm, she received a call from EMT stating they found R1 by his/herself.

As a result, An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility.

Deficiencies cited during today's visit. Administrator refused to sign. ADM stated he wanted LPA to delete photos of inside of shed. LPA stated, the ongoing complaint investigation regarding the shed is still under investigation. LPA informed ADM the photos taken of the shed will not be deleted.

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NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 09/25/2025 05:13 PM - It Cannot Be Edited


Created By: Manuel Monter On 09/25/2025 at 04:25 PM
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: 09/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87307(d)(6)
Personal Accommodations and Services
(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. LPA observed the side gate had a lock, obstructing the side exit. (Photograph of the lock gate was taken.) ADM stated the gate is locked because resident R1 has wandering behaviors. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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ADM removed the lock during the visit. ADM stated she will send a letter of understanding regarding the regulation and the importance of keeping passageways cleared. ADM stated she will submit the plan of correction by POC date, September 26, 2025.
Type A
Section Cited
CCR
87468.2(a)(4)
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above. On September 16, 2025, resident R1 eloped from the facility and staff were unaware that R1 had left the home unassisted. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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ADM stated she will submit a written plan of action on how she will ensure the facility staff are meeting the supervision needs of R1. ADM stated she will submit the plan of correction by POC date, September 26, 2025.
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: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/25/2025 05:13 PM - It Cannot Be Edited


Created By: Manuel Monter On 09/25/2025 at 04:25 PM
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: 09/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87463(a)
Reappraisals
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Record review and interview , the licensee did not comply with the section cited above. Based on a review, resident R1's needs and services plan has not been updated, and does not address R1's wandering behavior. ADM stated she has not yet updated R1's care plan. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/02/2025
Plan of Correction
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ADM stated she will send an updated care plan for R1. ADM stated she will send a letter of understanding regarding the regulation. Based on a review, resident R1's needs and services plan has not been updated, and does not address R1's wandering behavior. ADM stated she will submit the plan of correction by POC date, October 2, 2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2025


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 09/25/2025 05:13 PM - It Cannot Be Edited


Created By: Manuel Monter On 09/25/2025 at 04:27 PM
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: 09/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
87468.1(a)(1)
87468.1 Personal Rights of Residents in All Facilities (a) (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above. LPA's observed resident R2 seated in a wheel chair in front of the dinning room. LPA's then noted resident's wheel chair was tied to the dinning table. Staff S2 and S3 stated they have been tying R2 for over a month. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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ADM stated she will conduct a personal rights training to her staff regarding restraints. ADM stated she will send documentation showing this training has taken place, including names of those who attended, the length of the training and the trainer. ADM stated she will also send a letter of understanding regarding the regulation. ADM stated she will submit the plan of correction by POC date, September 26, 2025.
Type A
Section Cited
CCR
87468.1(a)(2)
87468.1 Personal Rights of Residents in All Facilities (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above. ADM confirmed the cameras inside the facility do record with audio. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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ADM stated she will submit a letter of understanding regarding the regulation, and the importance of ensuring the inside of the facility does not have any audio recording. ADM stated she will submit the plan of correction by POC date, September 26, 2025.
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: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2025


LIC809 (FAS) - (06/04)
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