<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294079
Report Date: 01/09/2025
Date Signed: 01/09/2025 12:06:38 PM

Document Has Been Signed on 01/09/2025 12:06 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/
DIRECTOR:		GARCIA, AMPARO QUEFACILITY TYPE:
740
ADDRESS:3427 GILA DRIVETELEPHONE:
(408) 270-4060
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 3DATE:
01/09/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Cecilia Ansagay S1 TIME VISIT/
INSPECTION COMPLETED:
12:10 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) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Staff S1 Cecilia Ansagay. Administrator Amparo Garcia was not able to come to facility for personal reasons was contacted via telephone. LPA announced the purpose of the visit.

During visit, LPA Yanez toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature measured with thermometer was 45 degrees F and freezer was 0 degrees F

LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA had Staff S1 test the smoke detectors in the hallway and found the smoke detector to function properly when tested LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 131 to 141 degrees F, second time was tested at 130 to 138 degrees F. and third time was tested at 130 to 138 degrees F.

LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 3/27/23. LPA was not able to review resident files and staff files S1 did not have access to files. Designated Administrator was not able to come to facility for personal reasons.

Deficiencies were cited as per California Code of Regulations Title 22 (see LIC 809D) This report was reviewed with Administrator Amparo Garcia over the phone and ADM agreed to have S1 sign on their behalf and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 01/09/2025 12:06 PM - It Cannot Be Edited


Created By: Marcela Yanez On 01/09/2025 at 11:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: RIVER PARK HOMES II
FACILITY NUMBER: 435294079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by not maintaning the water temperature between 105 degrees F to 120 degrees F water temperature measured wiyh thermometer between 130 to 141 degrees F. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
1
2
3
4
Licensee will submit a letter of understanding of the regulation and submit a monthly log of water temerature to the department will submit log via email and letter of understanding by the POC date 1/10/2025
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Marcela Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/09/2025 12:06 PM - It Cannot Be Edited


Created By: Marcela Yanez On 01/09/2025 at 11:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: RIVER PARK HOMES II
FACILITY NUMBER: 435294079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87755(c)
87755 Inspection authority of licensing agency
(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying.


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, and interview the licensee did not comply with the section cited above by not having the resident and staff files available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2025
Plan of Correction
1
2
3
4
Letter of understanding of regulation and submit it via email to the department by the POC date of 1/16/2025
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Marcela Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3