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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202775
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:26:00 PM

Document Has Been Signed on 12/19/2024 12:26 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:WATERMARK AT ALMADEN, THEFACILITY NUMBER:
435202775
ADMINISTRATOR/
DIRECTOR:		COREY MILLERFACILITY TYPE:
740
ADDRESS:4610 ALMADEN EXPRESSWAYTELEPHONE:
(669) 258-4567
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY: 240CENSUS: 166DATE:
12/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Administrator Corey MillerTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Corey Miller . During the visit, ADM stated the Assisted living has 135 residents and memory care has 31 residents. LPA explained the purpose of the visit.

LPA toured all 4 floors of the facility inside out with ADM which included the Activity rooms, kitchen, dining room and restrooms. LPA randomly inspected the following assisted living resident bedrooms: 216, 301, 303, 313, 327,403 The staff area of the facility was also inspected. LPA also randomly inspected the following bedrooms in the facility memory care unit; 141, 144, 147, 163. LPA tested delayed egress, which activated when pushed. The front and back of the facility was inspected. There was no obstruction to block the walkways.

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 70 degrees F. LPA tested hot water temperature in 4 random resident bedroom, which measured to range from 114 to 116 degrees F.

Fire extinguisher was serviced in November 2, 2024. The facility's last sprinkler system inspection was completed on September 2024. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on October 7, 2024.

LPA reviewed facility records for 5 staff and 5 residents. LPA reviewed 5 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff and 4 residents.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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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: WATERMARK AT ALMADEN, THE
FACILITY NUMBER: 435202775
VISIT DATE: 12/19/2024
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LPA requested copies of the following documents be sent to LPA:
1.LIC 308, Designation of Administrative Responsibility
2.LIC400, Affidavit Regarding Client/Resident Cash Resources
3. Liability Insurance
4. Qualifications of Administrator (Certificate)
5. Please review your facility program for updates (incorporating new laws and/or regulations)

LPA provided Dementia Care and RCFE regulation updates flyer.

No deficiencies cited during today's visit. This report was reviewed with Administrator Corey Miller and a copy of the signed report was provided.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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