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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294351
Report Date: 07/30/2024
Date Signed: 07/30/2024 09:18:18 AM


Document Has Been Signed on 07/30/2024 09:18 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:SWEET DREAMS CARE HOME LLCFACILITY NUMBER:
435294351
ADMINISTRATOR:JEAN JOSEFACILITY TYPE:
740
ADDRESS:1187 PARK GROVE DRIVETELEPHONE:
(408) 941-9995
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:6CENSUS: 5DATE:
07/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Administrator Jean JoseTIME COMPLETED:
09:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management- Deficiencies visit. LPA met with Administrator (ADM) Jean Jose. LPA explained the purpose of the visit. During the visit, LPA observed 5 residents and 2 staff.

The purpose of the visit is regarding to deficiencies cited on December 14, 2023 and to verify that the plan of corrections are being followed. The following are the some of the deficiencies cited that are being inspected today which included the following;
1. Fire clearance; for residents residing in the garage and not following their fire clearance.
2. Operating beyond the conditions and limitations specified on the license
3. Personal Rights; for residents residing in the garage
4. Non-skid Mats; It was observed a shower did not have the non-skid mats.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The front yard and backyard were inspected. There was no obstruction to block the walkways. LPA toured the facility garage. LPA observed the garage being used as a storage area.

No deficiencies cited during today's visit. This report was reviewed with Administrator Jean Jose and a copy of the signed report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
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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