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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202744
Report Date: 12/28/2024
Date Signed: 12/28/2024 12:56:25 PM

Document Has Been Signed on 12/28/2024 12:56 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:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Resident Service Director Jmy Ramos. TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Manuel Monter and Marcela Yanez conducted an unannounced Case Management to conduct a Non-Compliance Plan Quarterly Visit and met with Resident Service Director Jmy Ramos. Administrator was not present at the facility and busy at the time of the visit.

The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) after an informal meeting held on 04/26/2024.

LPA's toured the memory care unit and tested the delayed egress doors in the memory care unit. The delayed egress doors made an auditory sound when pressed.

LPA Monter reviewed staff in-service training summaries conducted from 08/01/2024 - 12/01/2024 on topics included but not limited to: Resident right to privacy, reporting abuse, Dementia care: working with hospice, theft and loss, & elopement.

No deficiencies cited per California Code of Regulations, Title 22. This report was reviewed with Resident Service Director Jmy Ramos and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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)
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