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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202943
Report Date: 09/24/2024
Date Signed: 09/24/2024 04:26:08 PM

Document Has Been Signed on 09/24/2024 04:26 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:LOVING HEART CARE HOMEFACILITY NUMBER:
435202943
ADMINISTRATOR/
DIRECTOR:
SILVA, ARMANDO N.FACILITY TYPE:
740
ADDRESS:251 DELIA STREETTELEPHONE:
(559) 572-9755
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 6CENSUS: 3DATE:
09/24/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Armando SilvaTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an pre-licensing inspection visit and met with Administrator (ADM) Armando Silva. Two residents and two staff were observed in the facility.

Living room, dining room, kitchen, 3 shared resident bedrooms, 1 staff live-in room, 2 resident restrooms, 1 staff restroom, and laundry room were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Room temperature was observed at 82 degree F. Hot water temperature was observed at 107 degree F. Bars and non-skid mats were observed in the restrooms. Resident bedrooms were observed with window screens. The temperature of the refrigerator was measured at 40 degree F and the temperature of the freezer was measured at 0 degree F.

Fire extinguisher was serviced on 09/08/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Medications closet, knives closet were observed locked.

Medications closet was observed locked. Knives closet and dish washing solution closet were observed locked. First aid box, flash lights and night lights were observed in the facility.
LPA toured the backyard with ADM. Three storage rooms were observed at the backyard. One big room with 2 bedrooms, 1 living room, kitchen and garage inside was observed at the backyard. The big room at the backyard has a drive way and exit door to exit the property. The big room has no access to the facility and with separate route to exit the property. ADM stated the landlord lives in the big room. No obstruction blocks the exits. The last time the facility conducted the emergency drill is on 7/15/2024.

Component III was conducted with ADM.
No deficiency/citation noted today. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was issued to ADM.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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