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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202895
Report Date: 12/13/2024
Date Signed: 12/14/2024 04:21:31 PM

Document Has Been Signed on 12/14/2024 04:21 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:MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSEFACILITY NUMBER:
435202895
ADMINISTRATOR/
DIRECTOR:
WELCH, JOYCEFACILITY TYPE:
740
ADDRESS:1380 S DEANZA BLVDTELEPHONE:
(669) 295-6500
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 149CENSUS: 76DATE:
12/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Joyce WelchTIME VISIT/
INSPECTION COMPLETED:
04:39 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Joyce Welch.

LPA reviewed 4 residents files and 4 staff files. License, Administrator Certificate, and personal rights posters were observed at main entrance.

LPA toured the facility inside and out with ADM. The facility has four stories and basement. The facility has 103 apartments/bedrooms with capacity of 149. LPA toured the basement, first floor, second floor, third floor and forth floor including lobby, front desk, bistro area, dining room, activity room, theater, salon, kitchen, resident apartments, medication room, spa, enrichment, fitness room, restrooms, activity rooms, offices, storage rooms, and laundry area. LPA inspected the courtyard.

Room temperature was observed at 70 degree F, hot water was observed at 114 degree F. Temperature of refrigerator was observed at 37 degree F, and the temperature of freezer was observed at 0 degree F. Food storage can hold the 2 days of perishable food and 7 days of non-perishable food for the entire building. Fire extinguishers were on service on 3/8/2024. The facility was equipped with smoke and carbon monoxide detectors. carbon monoxide detectors were tested, and were working fine. Medication rooms, medication carts, laundry room and chemical storage room were observed locked.

First Aid Kits were checked and found to be in compliance. Non-slippery floors and grab bars were installed in restrooms. The bedrooms has screened windows. The entire building hallways and common area had functioning light fixtures. LPA observed 2 functioning elevator in the facility. Evacuation chairs were found at the stairs. The last time the facility conducted the fire drill was on 11/20/24.
No deficiency noted today. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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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