Marbella San Jose

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted announced pre-licensing visit for Change of Ownership. LPA met with Executive Director/Administrator Zeinab Donner. The visit is for a pre-licensing change of ownership of Brookdale San Jose with license #435202447 to Marbella San Jose #435202971. The facility will not change any structural or layout of the building. The facility will serve adults 60 and over and under the same program plan, including dementia program. Applicant will retain 143 non-ambulatory, 10 may be bedridden, memory care unit is for 31 with delayed egress and assisted living for 122 and a hospice waiver for 20. The facility is composed of 3 parts, the assisted living and memory care section of the community will transition to the new ownership and applying for the license. Assisted Living has 61 rooms and Memory Care has 28 rooms. The independent living section of the community is not included in the licensing application. LPA toured the facility inside and outside, assisted living area, memory care unit, dining area, salon, library, activity area, 3 kitchen including the main kitchen that prepares the meals for the entire community (assisted living, memory care and independent living). LPA observed that residents were busy with different activities located at different areas of the assisted living and memory care. LPA observed memory care resident rooms are maintained and sanitary. The bathrooms have grab bars, and non-slip flooring. The hot water temperature is checked each week by the maintenance supervisor. “Oxygen in Use/No smoking” signs were observed posted outside the residents’ room where oxygen was administered. page 1 LP observed various on-going activities to celebrate 10/31/2025. Staff and residents were participating all throughout the facility. Activity calendar was observed posted at various locations throughout the facility. All common areas were free from obstructions, and hallways were well-lit. LPA inspected activity areas, library, media room, Theater room, exercise room, and other commons areas and observed residents actively engaged in recreational programs and activities. LPA observed the memory care rooms to be organized and sanitary, the kitchen is equipped with food warmers and has snack available for residents at all times. LPA inspected laundry rooms on each floor and observed working washer and dryer units. Sharp objects, detergents, and chemicals were observed to be locked and inaccessible to persons in care. LPA observed locked centrally stored medication carts in the Assisted Living and Memory Care units. LPA inspected the main kitchen and observed the kitchen to be organized and sanitary. The freezer and refrigerators are maintained at 0 degree F, the refrigerator is maintained at 32 degree F and checked temperature and log 5 times a day. LPA observed two (2) days of perishable food and nonperishable food for seven (7) days and is able to sustain 160 staff and 294 residents overall (assisted living, memory care and independent living) in case of an emergency. LPA toured the exterior part observed walkways are free from obstructions and tripping hazards. Delayed egress was observed in the memory care unit and a keypad to enter is required. No bodies of water was observed. LPA inspected observed fire extinguishers to be strategically placed in each floor and area of the Assisted Living and Memory Care that was recently inspected 10/13/2025. ED stated SSS Fire Protection Inc maintains their Automatic sprinkler systems quarterly and was checked last by SSS on 10/13/2025. Fire Detection Unlimited (FDU) and maintains the smoke alarm and carbon monoxide semi-annually and last inspection made was on 08/27/2025. COMP III was presented during this visit. LPA did not observed any areas to be corrected and the facility is ready to be licensed. An exit interview was conducted Zeinab Donner, Executive Director/Administrator and a copy of this report was provided. page 2the state’s words, verbatim · CDSS document, Oct 30, 2025

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Oct 24, 2025