<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202744
Report Date: 12/28/2024
Date Signed: 12/28/2024 12:55:03 PM

Document Has Been Signed on 12/28/2024 12:55 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:WESTMONT OF SAN JOSEFACILITY NUMBER:
435202744
ADMINISTRATOR/
DIRECTOR:		BECKER, GREGORYFACILITY TYPE:
740
ADDRESS:80 CEDAR WAYTELEPHONE:
(408) 770-9575
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 225CENSUS: 83DATE:
12/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Resident Service Director Jmy RamosTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Marcela Yanez and Manuel Monter conducted an unannounced Required 1 Year visit and met with Resident Service Director, Jmy Ramos, LPAs stated the purpose of the visit.

LPAs toured the facility inside and out, which include 4 floors . LPAs randomly inspected the following, but not limited to resident bedrooms: 450,471,485, 322,360, 367, 280, 270, 209. LPAs randomly tested the resident bathroom on each floor water temperature with thermometer and measured range from 106 to 112 degrees F.

LPAs toured the Memory Care unit inside and out. LPAs randomly inspected the following, but not limited to resident bedrooms: 105, 103, 125 LPAs randomly tested bathroom water temperature with thermometer and measured to range from 110 to 112 degrees F. LPAs tested delayed egress doors which activated auditory sound when pressed.

LPAs also inspected the dining area and kitchen of the facility. LPAs observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. No obstructions were noted during tour.

LPA toured the outside area and found the exits to be clear of obstructions. LPAs observed fire extinguisher was last serviced on 04/22/2024. LPA reviewed Fire and Earthquake log which stated the last drill was conducted on 11/25/24. The Sprinkler system was last serviced on 12/06/2024.

Page 1 of 2
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2024
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 2
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: WESTMONT OF SAN JOSE
FACILITY NUMBER: 435202744
VISIT DATE: 12/28/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA reviewed resident records for 5 residents and reviewed CSMDR and found to be complete. LPA reviewed 5 staff records and found them to be complete.

LPA provided Resident Service Director with a flyer "Important updates to Dementia Care & Miscellaneous Changes, Effective January 1, 2025."

No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Resident Service Director, Jmy Ramos and a copy of this report.

Page 2 Out of 2. END OF REPORT
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2