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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294079
Report Date: 01/25/2023
Date Signed: 01/25/2023 04:50:31 PM

Document Has Been Signed on 01/25/2023 04:50 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:RIVER PARK HOMES IIFACILITY NUMBER:
435294079
ADMINISTRATOR:GARCIA, AMPARO QUEFACILITY TYPE:
740
ADDRESS:3427 GILA DRIVETELEPHONE:
(408) 270-4060
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 3DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Amparo GarciaTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Licensee, Amparo Garcia. Licensee was informed of the facility's outstanding fees.

During visit, LPA toured the facility to include the dining room, living room, kitchen, resident rooms, bathroom, and backyard. All fire exit routes were free and clear of obstruction.

Facility has a central entry point for sign-in and temperature check. LPA did not complete a COVID screening questionnaire. LPA recommended the Licensee to continue screening visitors and staff. Hand sanitizer available at the entry. Visitor guideline posted at the entry. Bathrooms supplied with paper supplies, hygiene products, and hand washing sign. LPA observed the facility's PPE supplies. Facility staff are not trained on infection control. Licensee will ensure to train staff on infection control, ASAP. Facility staff clean and disinfect multiple times daily and as needed. Staff are not N95 fit tested. Licensee will get staff N95 fit tested. The following posters observed to include special visitors, feeling ill, keep facility clean, and cover your cough.

No deficiency cited per California Code of Regulations, Title 22. Advisory notes provided.

This report was reviewed with Licensee, Amparo Garcia and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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