435202988-4-29-2026-26-AS-MPAA-DTLJXT-20260429072648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202988
Report Date: 04/28/2026
Date Signed: 04/29/2026 07:30:51 AM

Document Has Been Signed on 04/29/2026 07:30 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:	PRIMAVERA GARDENS FACILITY LLC		FACILITY NUMBER:	435202988
ADMINISTRATOR/ DIRECTOR:	LANFORD, LISA		FACILITY TYPE:	740
ADDRESS:	16095 CHURCH ST		TELEPHONE:	(646) 416-1430
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY: 20		CENSUS: 19	DATE:	04/28/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Lisa Lanford		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived announced to conduct the facility's pre-licensing visit for change of ownership (CHOW). LPA met with current administrator (ADM) and applicant representative Lisa Lanford. There are 19 residents present at the facility. This facility address is currently licensed under Primavera Gardens with license #435202754. The applicant will transfer services to the new license once approved. The facility has approved fire clearance to serve adults 60 and over, capacity of 20 and all may be bedridden. The facility is retaining the same capacity and no changes in the number of resident and services provided. ADM stated that an additional room may be added in the future. During visit, LPA inspected the facility with ADM inside and outside to include the kitchen, activity room, outdoor perimeters, entry way, parking area, 13 residents room, shower rooms, lavatory that are shared, the laundry area and medication room. LPA observed that the facility has posters for the Local Long-Term Care ombudsman (LTCO) and California Compliance poster for assisted living and Residential Care Facilities for the Elderly (RCFE), it includes the emergency telephone numbers, personal rights, and facility sketch, notice of fire inspection from the Fire Department. The entry way has the Personal Protective Equipment (PPEs). Medications, chemicals and sharps are locked in their respective areas and are not accessible to residents in care. The first aid kit are readily available when needed. page 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

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: PRIMAVERA GARDENS FACILITY LLC	FACILITY NUMBER: 435202988
	VISIT DATE: 04/28/2026

NARRATIVE

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LPA observed that the facility is equipped with lift equipment, and hospital beds that has half body rails and full body rails. Bathrooms were supplied with hygiene products and paper supplies, grab bars, anti slip mats and shower chairs. The resident rooms have sufficient storage to store personal belongings. Resident's room are kept sanitary and organized.

LPA observed surveillance camera located at the common area (hallways, activity area and the exterior perimeter). The facility is equipped with fire sprinklers, fire and carbon monoxide alarm system and a wall fire pull alarm system. The facility is equipped with door alarm system. The facility has 4 fire extinguishers. All fire exit routes were free and clear of obstruction and tripping hazards.

Water temperature was within regulatory range of 115 to 118 degree F when measured with a digital thermometer. The facility temperature is at 68 to 70 degree F. LPA observed 2 days of perishable and 7 days of non-perishable foods. The refrigerator temperature is at 36 degree F and Freezer is at 0 degree F.

The facility is a one story building with no ramps, the parking lot has designated ADA (Americans with Disability Act) compliant parking spaces, the outdoor area is maintained and no hazardous materials were observed. The exterior walkways are free from obstructions. The facility is gated and has perimeter fence for safety of the residents. The gates remains opened during business hours.

Component III was presented and discussed with administrator Lisa Lanford. Pre-licensing inspection is complete and this facility has no deficiencies/corrections. Report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. The license #435202988 for Primavera Gardens Facility LLC is not active as of today's pre-licensing inspection. The application is subject to final approval by Central Application Bureau (CAB) and additional requirements may still be requested to complete the application.

An exit interview was conducted with Administrator and applicant's representative Lisa Lanford and a copy of the report was provided.

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end of report

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC809 (FAS) - (06/04)

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