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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202943
Report Date: 10/13/2025
Date Signed: 10/15/2025 08:29:20 AM

Document Has Been Signed on 10/15/2025 08:29 AM - 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:
10/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Armando SilvaTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection visit and met with Administrator (ADM) Armando Silva, and stated the purpose of the visit.

The facility is licensed to serve adults 60 years old and over 6 non-ambulatory, bedrooms #1 and #3 are approved for both non-ambulatory and bedridden individuals and bedroom #2 is approved for non-ambulatory only. The facility has a hospice waiver for 6.

LPA was accompanied with ADM during inspection of the facility inside and outside. The facility exterior has a ramp with missing plank creating a gap between planks and is a tripping hazard. LPA observed boxes of fruits and vegetables exposed to the element and starting to dry up and rot, collecting dust and attracts insects. ADM stated that the boxes of fruits and vegetables are property of the lessor who stays in the converted garage. LPA observed 2 vehicle parked in the side driveway and ADM stated the vehicles belongs to the lessor. The facility has cemented/paved garden area that is uneven and may pose as a tripping hazard. LPA observed 2 sheds used for storing supplies and wheelchairs no longer in use.

Inside the facility, LPA observed 3 resident bedroom all are shared and 1 staff room. 3 bathroom, laundry area, kitchen, dining and main living room. The residents bedroom have functioning lights, clean bed linens, storage for resident's personal belongings. Resident's bathroom are equipped with anti skid/slip mats and grab bars. The hallways and walkways inside the facility are free from obstruction and debris and is well lighted. LPA observed laundry supplies and chemicals are locked and not accessible to residents in care.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: LOVING HEART CARE HOME
FACILITY NUMBER: 435202943
VISIT DATE: 10/13/2025
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In the kitchen, LPA observed that sharps and medications are locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. LPA observed that the kitchen is clean and organized. The kitchen and bathroom water temperature measured at 139.9 degree F to 141.1 degree F.

The facility is equipped with smoke and carbon monoxide alarm system and fire extinguisher was last inspected on 09/17/25.

LPA reviewed 3 staff record. 2 Out of 3 staff record training are outdated, 2 out 3 staff LIC 501, requires to state that they are employed by the facility and not by the old licensee. 3 Out of 3 staff has CPR/First Aid that are expired. 3 Out of 3 staff record have cleared fingerprint and criminal background record. 3 Out 3 staff health screening are cleared.

Due to time constraint, the annual inspection will be continued at a later date. The following deficiencies will be cited at a future date based on the initial observation of today's visit (10/13/2025), 87705 Care of Persons with Dementia, 87411 Personnel Requirement, 87412 Personnel Record, 87303 Maintenance and operation and 87555 General Food Service Requirements.

An exit interview was conducted with Administrator Armando Silva and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC809 (FAS) - (06/04)
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