Illustration — no photo of this home on file yet
- Care approvals on fileWheelchair · BedriddenState licensing record · September 27, 2026
- Estimated starting rate$3,800 a monthCovelight estimate · likely $3,100–$4,650
- Home sizeLicensed for 6Small care home · a licensed care home (RCFE)
- Room at the last state visit6 of 6 beds occupiedSeptember 17, 2024 · not a current opening
- Ways to payAsk the homeMedi-Cal ALW participation not on file
- Last state visitAugust 26, 2026CDSS inspection record
Rgk Home Care is a small care home in San Jose — a licensed residential care facility for the elderly (RCFE), the licence category behind “assisted living” and “board and care.” It is licensed for 6 residents since 2023. Dementia care and hospice care are not on file.
Built from CDSS public records · September 27, 2026. Every fact below names its source and date.
Quick answers and the state record
A citation does not make a home unsafe, and an empty file does not make a home good.
Quick answers about Rgk Home Care
Is Rgk Home Care licensed?
The state lists this license as “Licensed,” per CDSS records as of September 27, 2026.
How many residents is Rgk Home Care licensed for?
6 residents — a small home, per CDSS records as of September 27, 2026.
Has Rgk Home Care been cited?
0 Type A and 2 Type B citations since 2023, per CDSS records as of September 27, 2026. Those records count 13 state visits over the same years.
Is Rgk Home Care still open?
This license was on the CDSS roster as of September 28, 2026.
What does Rgk Home Care cost?
$3,800 a month to start is a Covelight estimate, likely $3,100–$4,650. This home’s own rate is not on file. Ask: “What is the all-in monthly rate, and what would push it higher?”
Covelight’s estimate starts from the rates 9 small homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.
Among 51 other homes of a similar licensed size in San Jose that publish a starting rate, the middle half runs $3,525 to $4,875 a month, and the middle figure is $4,200 (n = 51 other homes publishing a starting rate).
Each of those is a home’s own published figure, gathered on its own date in September 2026 — not an average of ours, and not a survey. Similar size means small and mid-size homes counted together, and large communities counted on their own, because they are different markets.
A home outside the band is not overcharging or underpricing: a starting rate covers different things in different homes, which is the first thing to ask about.
The price is made in the phone call. Nothing here is a quote, an offer or a discount.
A starting rate is the room and the base care. California homes commonly bill care levels, medication management, supplies, transport and a second person in the room as extras. Many also charge a one-time fee at move-in. Ask for that list in writing before anything is signed.
Only prices a home put out itself count here: its own website, a listing it supplied, or a price a listing site says the home confirmed. Prices a site shows without saying where they came from are left out.
Does Rgk Home Care take Medi-Cal?
On Medi-Cal’s Assisted Living Waiver: this home is not on the DHCS participation list dated September 23, 2026. Ask the program about current options. The waiver pays for care services, not room and board.
Who holds the license?
The license is held by Cruz, Ravenal D. & Lazaro, Mary Grace V., per CDSS records as of September 27, 2026.
Is there a hospital nearby?
Kaiser Foundation Hospital-San Jose is 2.9 miles away in a straight line, per the CDPH licensed-hospital list dated September 16, 2026. See licensed care homes near it.
Can Rgk Home Care keep a resident on hospice?
Not on file — the state’s record does not list hospice care on this license. Ask: “Can a resident stay here on hospice, and under what conditions?”
Rgk Home Care license and inspection record
- Name on the license: “RGK HOME CARE”, per the CDSS roster as of May 25, 2025.
- License #435202891. The state lists this license as “Licensed,” per CDSS records as of September 27, 2026.
- Licensed for 6 residents — a small home, per CDSS records as of September 27, 2026.
- Licensed to Cruz, Ravenal D. & Lazaro, Mary Grace V., per CDSS records as of September 27, 2026.
- First licensed in 2023, per CDSS records as of September 27, 2026.
- 13 state inspection visits since 2023, per CDSS records as of September 27, 2026.
- 0 Type A and 2 Type B citations on file since 2023, per CDSS records as of September 27, 2026. The same records count 13 state visits in that period.
- 1 complaint and 1 substantiated allegation on file since 2023, per CDSS records as of September 27, 2026. One complaint can carry several allegations.
- The most recent state visit on file is August 26, 2026, per CDSS records as of September 27, 2026.
California writes these definitions for every licensed home, not for this one. CDSS citation definitions (PDF) ↗
Can they support the care needed?
California licenses a home for specific kinds of care. The state’s record lists what this home is approved for; the home’s own answers fill in what changes as needs change.
- Wheelchair / non-ambulatoryApproved · covers up to 5 residents
- Dementia / memory careNot on file · ask the home
- Hospice careNot on file · ask the home
- BedriddenApproved by the state
State licensing record · September 27, 2026. An approval may cover specific rooms or residents; it does not establish an opening.
Read the state’s own wording
AGE RANGE 60 AND OVER. APPROVED FOR 5 NON-AMBULATORY AND 1 BEDRIDDEN. GARAGE OFF LIMITS/NOT FOR LIVING PURPOSES.
935 - ELDERLY
CDSS record, verbatim · September 27, 2026
As needs change
5 questions to ask the home — nothing on file yet
- Two-person transfers or a lift
Not on file
Ask: “If two people or a lift are needed to transfer, can the person stay?”
- Someone awake overnight
Not on file
Ask: “Who is awake overnight, and how do residents ask for help?”
- Medicines
Not on file
Ask: “Who manages the medicines, and what happens when a dose is missed?”
- Staying through hospice
Hospice waiver not on file
Ask: “If hospice is needed, can care continue here until the end?”
- If memory loss develops
Dementia-care designation not on file
Ask: “If memory loss develops, what would change — and when would a move be needed?”
What it costs here
Covelight estimate
$3,800a month to start
Likely $3,100–$4,650
From 9 nearby homes that publish rates · this home’s rate is not on file
Likely monthly total
$3,800a month
Likely $3,100–$4,850
With a shared room and basic help.
An estimate for planning, not a quote. The price is made in the phone call.
See the full cost breakdownRoom, care and fees · how people pay · how this estimate works
Memory care is not priced here: a dementia-care designation is not on file for this home. Ask the home.
Starting monthly rate$3,800likely $3,100–$4,650
Covelight’s estimate starts from the rates 9 small homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.
Basic help with daily careUsually includedup to $600
Basic help is usually part of the starting rate. Homes that price care by level start around $600 a month (45 California homes publish a care-level range, seen in September 2026).
One-time move-in fee$2,000one time · likely $0–$4,000
Homes that list a one-time entry or community fee charge a median of $2,000 (134 California listings; middle half $1,000–$4,000). Many homes list none — ask.
- Likely monthly totalLikely $3,100–$4,850
- $3,800
- First monthWith a one-time move-in fee · likely $3,650–$8,100
- $5,800
How people payPrivate pay, Medi-Cal waiver, SSI/SSP, veterans, insurance
- Private payMost residents pay from savings, a home sale or family help. Ask for the rate and what it includes in writing.
- Medi-Cal Assisted Living WaiverThis home is not on the DHCS participation list dated September 23, 2026. Ask the program about current options. The waiver pays for care services, not room and board.
- SSI/SSPCalifornia’s 2026 standard is $1,626.07 a month; $1,444.07 of it goes to the home and $182 stays with the resident. Whether this home accepts it is not on file — ask.
- VeteransVA Aid & Attendance can add to a veteran’s or surviving spouse’s pension. Ask whether residents here have used it.
- Long-term care insuranceMost policies pay for licensed care homes. Ask what paperwork the home provides for claims.
- MedicareDoes not pay for room and board in a care home. It can still cover hospice or home-health visits inside one.
Avoid surprises on the billWhat changes the price, and what to ask
- The care level
Some homes charge one all-inclusive rate. Others add levels or points as needs grow. Ask how the level is set, who decides, and what the next level costs.
- What is billed separately
Medication management, incontinence supplies, transportation and a second person in the room are often extra. Ask for the list in writing.
- Move-in costs
A one-time community fee or deposit is common. Ask what it covers and whether any of it comes back if the stay is short.
- Increases
California requires at least 90 days’ written notice, with reasons, before a rate rises (Health & Safety Code §1569.655). A change in the resident’s care level is the section’s own exception and can be billed sooner.
- What is the full monthly cost for the room and care we need, and what does it include?
- What would the next care level cost, and who decides when it changes?
- What is billed separately, and is there a one-time fee or deposit at move-in?
- Is any private-pay period required before another payment program can begin?
How this estimate worksWithin 25% for 7 in 10 homes in testing
Covelight’s estimate starts from the rates 9 small homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.
9 homes like this within 3 miles publish starting rates mostly between $2,650–$4,200.
- Only prices a home put out itself count: its own website, a listing it supplied, or a price Seniorly says the home confirmed. Prices a listing site shows without saying where they came from are left out.
- Nearby homes are the nearest of the same size that publish a rate, widening from 3 to 40 miles until at least 8 do. The estimate starts from what they charge, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices.
- Room, care-level, second-person and move-in lines come from what California homes publish on listing sites. Memory care uses Covelight’s researched premium over assisted living.
- Totals add each line’s figure and combine the lines’ ranges as separate charges, because a home is rarely at the top, or the bottom, of every line at once.
- We tested this estimate on 1,546 California homes that publish their own starting rate. It was within 10% of the real rate for 3 in 10 homes and within 25% for 7 in 10; the likely range held the real rate for 6 in 10 (September 12, 2026).
- It cannot see this home’s specials, how it assesses care, or which rooms are open.
Show the 9 nearby homes behind this estimate
- Real Elderly CareSan Jose · 0.8 mi · Small home$3,000Listed on Seniorly · seen September 9, 2026
- Saint Michael Residential HomeSan Jose · 1.5 mi · Small home$2,700Listed on Seniorly · assisted living shared bedroom · seen September 9, 2026
- Mayflower Care HomeSan Jose · 1.5 mi · Small home$4,000Listed on Seniorly · seen September 9, 2026
- Safe Haven Villa Care HomeSan Jose · 1.5 mi · Small home$3,200Listed on Seniorly · assisted living shared bedroom · seen September 9, 2026
- Sandy's Residential Care HomeSan Jose · 2.0 mi · Small home$4,200Listed on Seniorly · assisted living shared bedroom · seen September 9, 2026
- Pendar's Residential CareSan Jose · 2.0 mi · Small home$4,200Listed on Seniorly · assisted living shared bedroom · seen September 9, 2026
- Constantin's Care HomeSan Jose · 2.1 mi · Small home$2,500Listed on Seniorly · assisted living shared bedroom · seen September 9, 2026
- Oak Grove Residential Care HomeSan Jose · 2.4 mi · Small home$3,000Listed on Seniorly · assisted living shared bedroom · seen September 9, 2026
- Laurel Crest ManorSan Jose · 2.5 mi · Small home$4,200Listed on Seniorly · assisted living shared bedroom · seen September 9, 2026
Where it is
- 274 Clearpark Circle, San Jose, CA 95136Address from the public record · September 27, 2026. Confirm the entrance with the home before visiting.
Opening the neighborhood map…
The state record
California inspects every licensed home and publishes what it found. Here are the dated documents and the state’s own words, beside what is typical for homes this size.
Since 2023, the state has filed 13 documents for this home, and its records count 13 visits since 2023. The most recent is a facility evaluation report, dated August 26, 2026.
- On file since
- 2023
- State visits
- 13
- Most recent visit
- August 26, 2026
- Occupied · September 17, 2024 visit
- 6 of 6 bedsa count on that day, not an opening
We hold 1 complaint report the state published for this home, dated September 17, 2024. 1 of the 1 carries the state's recorded outcome word: “Substantiated” (1). 1 includes the transcribed allegation the state investigated, word for word. Summary composed by computer from the 1 complaint report below — every count derives from them, and the documents themselves are the state's records, verbatim. We never grade, score, or color a record.
Beside homes the same size
- Type A citations0typical 0
- Type B citations2typical 0
- Substantiated allegations1typical 0
- Total complaints1typical 0
“Typical” is the statewide median across the 6,808 licensed small board-and-care homes (6 or fewer beds) in the state record — larger, longer-licensed homes accumulate more visits and reports, so compare like with like. One complaint can contain several allegations. Counts cover this licence since 2023.
Year by year
The last 36 months — 11 of 13 documents
Aug 26, 2026Facility evaluation reportReport on file
Type of visit: Case Management - Legal/Non-compliance
On 08/26/2026, Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Case Management–Noncompliance Monitoring visit. Upon arrival, LPA was greeted by three staff. The licensee/administrator Mary Grace Lazaro and Ravenal Cruz was not present at the facility at the time of the inspection and arrived at the facility approximately 10 minutes after LPAs arrival. The facility remains under increased monitoring pursuant to the Compliance Plan established during the Noncompliance Conference conducted on December 3, 2024. The Compliance Plan requires monitoring inspections every three months for two years. This visit represents the second-to-last monitoring visit within the two-year monitoring period. The purpose of the visit was to evaluate the facility’s implementation of the Compliance Plan addressing care and supervision, facility security, resident reappraisals, staff training, acceptance and retention, collaboration with responsible persons and involved agencies, licensee and administrator accountability, incident reporting, staffing, and nighttime supervision. At the time of the visit, 3 out of 6 residents and 3 staff were present. One resident was hospitalized and 2 arrived from the day program after 4:30 p.m. page 1 LPA toured the facility’s interior and exterior areas and inspected the front exit, rear exit, and side exit located in a resident bedroom. LPA tested the alarm on each of the three exits. Each alarm produced an audible chime when the corresponding door was opened. From a distance, the chime could be heard; however, the specific door being opened was not readily distinguishable. When LPA moved closer to the alarm system, the announcement identifying the activated door was understandable. LPA interviewed three staff regarding resident supervision, scheduled resident checks, staffing coverage, door-alarm response, missing-resident procedures, incident reporting, and staff training. Three of three staff stated no current resident demonstrated active elopement, wandering, or exit-seeking behavior. Staff stated they reviewed residents’ Individual Program Plans, appraisals, needs and services plans, medical information, and other records to identify residents’ care and supervision needs. Three of three staff stated they would check the applicable exit when a door alarm activated. Staff stated the alarms could be heard throughout the facility; however, one of three staff stated the alarm announcement could be difficult to understand when the facility was noisy. Two of three staff stated alarms were tested weekly, while one of three staff identified the administrator as responsible for testing the alarms but did not identify the testing frequency. One of three staff recalled a prior occasion when part of the rear-door alarm became displaced and the alarm did not activate until staff identified and corrected the problem. Staff provided inconsistent information regarding scheduled resident checks. One of three staff described daily body checks and hourly nighttime checks, one of three staff stated residents were checked every 15 minutes, and one of three staff described frequent or daily checks without identifying the required frequency. Staff stated incomplete checks were communicated to the following shift. The interviews did not establish a consistent understanding of which residents required scheduled supervision checks or how missed checks and residents’ absences from the facility were documented. page 2 Three of three staff stated they would search the facility and surrounding areas and notify the administrator if a resident could not be located. Staff provided different responses regarding when 9-1-1 or law enforcement would be contacted. One of three staff stated staff might wait approximately 30 minutes to one hour, one of three staff stated law enforcement would be contacted when staff could not locate the resident, and one of three staff stated law enforcement would not be contacted immediately and the administrator would be notified first. Three of three staff stated an incident report would be completed following an elopement or missing-resident incident. Staff identified the administrator as responsible for submitting the report to Licensing. Staff did not consistently identify all required notifications, reporting time frames, resident reassessment, revision of the resident’s supervision plan, or other follow-up actions following the resident’s return. Staff also provided inconsistent information regarding staffing and the person designated to be in charge when the licensee/administrator was absent. Staff identified different persons as the designated person in charge. One of three staff stated at least two staff were always present, one of three staff stated the staff member was alone with six residents after approximately 5:00 p.m., and one of three staff stated four staff worked each shift and stated that he/she did not work alone. Three of three staff reported receiving training or instruction related to resident care, behavioral needs, missing-resident procedures, elopement, or incident reporting. Staff did not consistently describe the content of the training or demonstrate a consistent understanding of the facility’s procedures regarding staffing, scheduled resident checks, chain of command, emergency notifications, and follow-up after an elopement or missing-resident incident. page 3 LPA reviewed 3 out of 6 residents’ records, including Individual Program Plans, appraisals, needs and services plans, progress notes, and resident-checking logs. The records were reviewed determine that residents’ current supervision needs, scheduled checks, known behaviors, resident-specific interventions, and staff responsibilities were documented and updated following incidents or changes in condition. LPA reviewed the current LIC 500 Personnel Report, staff schedules, time records, and shift assignments for month of August 2026. The records were reviewed determined that staffing was maintained during all shifts, including nighttime hours. LPA reviewed staff training records, training materials, attendance records, and alarm-testing records. The records were reviewed and determine that staff received the training required by the Compliance Plan, that the facility regularly tested its alarms, and when alarm malfunctions a corrective actions were documented. LPA reviewed incident reports and notification records from May 2026 through August 26, 2026. The records were reviewed determined that incidents were reported to the Department within the required time frames, and responsible persons and other involved agencies were notified, and residents were reassessed following incidents or changes in behavior are monitored. Based on observations, interviews, and records reviewed, the facility was found to be in compliance with the December 3, 2024 Noncompliance Conference Compliance Plan. Staff responses varied regarding scheduled checks, staffing, the designated person in charge, and missing-resident procedures. The licensee/administrator was advised to review these procedures with all staff to ensure consistent implementation. No deficiencies were cited during today’s visit. An exit interview was conducted with Mary Grace Lazaro and Ravenal Cruz and a copy of the report was provided. Page 4the state’s words, verbatim · CDSS document, Aug 26, 2026
May 1, 2026Facility evaluation reportReport on file
Type of visit: Case Management - Legal/Non-compliance
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management - Legal/Non-compliance inspection and met with House Manager (HM) Golda Mediante . The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) office after a Non-Compliance Conference held on 12/03/2024. The case management of inspections will be conducted every 3 months for 2 years. 4 residents went to day program. LPA observed 2 residents and 3 staff in the facility. LPA reviewed and discussed the plan of correction for the deficiencies and the plan of operation the facility submitted for the NCC meeting with the HM. LPA reviewed the appraisal needs and service plan of 6 residents. LPA toured the facility with ADM. LPA checked the 3 door alarms of the facility and 2 moving detectors alarms outside the building. All were observed working. LPA reviewed the facility staff training log. LPA reviewed the 15 minutes resident checking log. Exit interview was conducted with HM. The report was provided to HM for signature. A copy of the report was provided to HM.the state’s words, verbatim · CDSS document, May 1, 2026
Feb 27, 2026Facility evaluation reportReport on file
Type of visit: Required - 1 Year
Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Licensee (LN) Mary Grace Lazaro. Administrator Ravenal De Guzman Cruz arrived shortly after. During the visit, LPA observed 2 residents and 4 staff. LPA explained the purpose of the visit. RGK Home care is a level 5 home. LPA toured the facility inside out with LN which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 72 degrees F, and hot water temperature was measured at 119 degrees F in resident bathrooms. Fire extinguisher was serviced in January 13, 2026. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on February 15, 2026. Page 1 Out of 2. LPA reviewed facility records for 3 staff and 6 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed 3 resident P&I records. No deficiencies cited during today's visit. This report was reviewed with Administrator Ravenal De Guzman Cruz and a copy of the signed report was provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Feb 27, 2026
Feb 27, 2026Facility evaluation reportReport on file
Type of visit: Case Management - Legal/Non-compliance
Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management - Legal/Non-compliance inspection and met with Licensee Mary Grace Lazaro. Administrator Ravenal De Guzman Cruz arrived shortly after. The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) office after a Non-Compliance Conference held on 12/03/2024. The case management of inspections will be conducted every 3 months for 2 years. During the beginning of the case management visit, LPA observed 4 residents depart for their day program. LPA observed 2 residents in the facility and 4 staff in the facility. LPA reviewed and discussed the plan of correction for the deficiencies and the plan of operation the facility submitted for the NCC meeting with the ADM. LPA toured the facility with ADM. LPA checked the 3 door alarms of the facility and 2 moving detectors alarms outside the building. All were observed as functional. . LPA reviewed the appraisal needs and service plan of 6 residents. LPA reviewed the facility staff training log and the 15 minutes resident checking log. Exit interview was conducted with Administrator Ravenal De Guzman Cruz. The report was provided to Administrator Ravenal De Guzman Cruz for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Feb 27, 2026
Jul 3, 2025Facility evaluation reportReport on file
Type of visit: Case Management - Legal/Non-compliance
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management - Legal/Non-compliance inspection and met with Administrator (ADM) Annie Inciso. The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) office after a Non-Compliance Conference held on 12/03/2024. The case management of inspections will be conducted every 3 months for 2 years. 2 residents went to day program. LPA observed 4 residents and 4 staff in the facility. LPA reviewed and discussed the plan of correction for the deficiencies and the plan of operation the facility submitted for the NCC meeting with the ADM. LPA reviewed the appraisal needs and service plan of 6 residents. LPA toured the facility with ADM. LPA checked the 3 door alarms of the facility and 2 moving detectors alarms outside the building. All were observed working. LPA reviewed the facility staff training log. LPA reviewed the 15 minutes resident checking log. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Jul 3, 2025
Apr 11, 2025Facility evaluation reportReport on file
Type of visit: Required - 1 Year
Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Mary Grace V. Lazaro. During the visit, LPA observed 2 residents and 2 staff. LPA explained the purpose of the visit. (RGK Home Care is a Residential Care Facility, Level home 4F) LPA toured the facility inside out with staff S1 which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the home LPA observed the family room, which was located adjacent to bedroom 4 and kitchen was modified to a staff room and hall way. LPA observed over half of the family room was now converted to a staff bedroom, and the rest was converted to a hallway. LPA spoke to the landlord of the home, who confirmed the changes to the facility were made prior to being license. The landlord stated he/she would look into getting a permit for the new staff room or removing it all together. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 108 degrees F in both resident bathrooms. Page 1 Out of 2. Fire extinguisher was serviced in December 5, 2024. the facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on March 2, 2025. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed 3 P&I records. No deficiencies cited during today's visit. This report was reviewed with Administrator Mary Grace V. Lazaro and a copy of the signed report was provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Apr 11, 2025
Mar 13, 2025Facility evaluation reportReport on file
Type of visit: Case Management - Legal/Non-compliance
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management - Legal/Non-compliance inspection and met with House Manager (HM) Annie Inciso. The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) office after a Non-Compliance Conference held on 12/03/2024. The case management of inspections will be conducted every 3 months for 2 years. LPA reviewed and discussed the plan of correction for the deficiencies and the plan of operation the facility submitted for the NCC meeting with the HM. LPA reviewed the appraisal needs and service plan of residents. LPA toured the facility with HM. LPA checked the 3 door alarms of the facility and 2 moving detectors alarms outside the building. LPA reviewed the facility staff training log. LPA reviewed the 15 minutes resident checking log. Exit interview was conducted with HM. The report was provided to HM for signature. A copy of the report was provided to HM.the state’s words, verbatim · CDSS document, Mar 13, 2025
Dec 3, 2024Facility evaluation reportReport on file
Type of visit: Office
A noncompliance meeting was conducted on 12/03/2024 at CCLD San Jose office. Present at the meeting were San Bruno Adult and Senior Care Regional Manager Vivien Helbling, Licensing Program Manager Romeo Manzano, Licensing Program Analyst Steve Chang, Manuel Monter, Marcela Yanez, facility Administrator Mary Grace Lazaro, facility Licensee Ravenal Cruz, and facility House Manager Annie Rose.. The purpose of the noncompliance meeting was to discuss substantiated complaint allegations. Deficiencies were cited for violations of Title 22 California Code of Regulations on 9/17/2024: 87468.1(a)(2), Personal Rights of Residents in All Facilities and 87211(a)(1)(D), Reporting Requirements On 05/31/2024 and 9/17/24, the Department conducted investigation regarding an elopement of a resident with developmental disability and neurocognitive disorder. The deficiency issued under Title 22 Regulations 87468.1(a)(2), Personal Rights of Residents in All Facilities was inadvertently issued a Type B instead of Type A. Type A violation is an immediate risk to the safety and health of residents. During the meeting, licensees were informed that the citation issued on 9/17/24, LIC9099-D, Title 22, Code section 87468.1(a)(2) will be amended from Type B to Type A. Noncompliance Conference Summary LIC 9111 and compliance plans were established during the meeting. The facility will begin a 2-year monitoring plan by licensing which includes more frequent licensing inspections. Report was reviewed with facility Licensee. A copy of this report, LIC 9111 and LIC 809-D deficiencies were issued and were provided to licensees during today's office visit. During visit, LPA provided a copy of CCL New Dementia Care Regulations Flier and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 3, 2024
From the deficiency page — Deficiency type: Type A · Section cited: CCR 87463(a) · Plan of correction due date: Dec 4, 2024
87463 Reappraisals(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. .... This requirement was not met as evidenced by: Based on the interviews and records reviewed on 5/31/2024, R1's appraisal needs and service plan was not updated after R1's elopement on 5/21/2024, which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in carethe state’s words, verbatim · CDSS document, Dec 3, 2024
Plan of correction: ADM and Licensee stated they will conduct a meeting with responsible party and staff and update re-apprisal for R1 and all residents as frequently as possible to ensure accuracy. Review all residents needs and services plan for all residents at least every 3 months and as needed,
From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(d)(1) · Plan of correction due date: Dec 4, 2024
87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in ....(1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidenced by: Based on R1's elopement on 5/21/2024, Administrator did not fulfill his/her duites & responsibility for providing care and supervision for R1. This poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 3, 2024
Plan of correction: ADM / Licensee stated they will conduct additional training for staff and themselves, regarding elopment, dementia, and re-apprisals. ADM and Licensee stated they will enroll in dementia training and other behavioral training.
From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 4, 2024
87464 Basic Services (f)Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as as evidenced by: Based on the interview with 3 staff (S1-S3), did not ensure R1's bedroom door was closed and the door alarm did not activate to alert staff when R1 left from the facility which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 3, 2024
Plan of correction: ADM stated they will make sure to check the residents every 15 mintues and check the doors. ADM stated they will also replace the door alarms as well.
Oct 4, 2024Facility evaluation reportReport on file
Type of visit: Case Management - Other
Licensing Program Analyst Manuel Monter and Marcella Tarin conducted an unannounced case management to amend a complaint (26-AS-20240523112616), LIC9099-D issued on September 17, 2024. LPA met with Administrator Mary Grace Lazaro and explained the purpose of the visit. The report issued on September 17, 2024 is being amended to issue a civil penalty for absence of supervision, which resulted in resident R1, eloping from the facility on May 21, 2024. The LIC9099-D deficiency will be amended due an erroneous error. The code section cited in the deficiency (87464 Basic Services(f)(1)) was incorrect, and the correct code section will be cited. No deficiencies were cited during todays visit. This Report was reviewed with Administrator Mary Grace Lazaro. A signed copy was provided.the state’s words, verbatim · CDSS document, Oct 4, 2024
Sep 17, 2024Complaint investigation reportSubstantiated
Allegation investigated: Facility staff did not observe resident was missing from the facility.
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Administrator (ADM) Mary Lazaro. On 05/23/2024, the Department received a complaint with the allegation that facility staff did not observe resident was missing from the facility. On 5/31/2024, LPA conducted an initial investigation visit. LPA interviewed Administrator, Licensee, 2 staff (S1, S2) and 2 residents (R1, R2). LPA requested resident R1's Individual Program Plan (IPP),Appraisal/Needs and Service Plan, and Physician Report. Continue on LIC9099-C. Page 1 of 3. Substantiated Facility staff did not observe resident was missing from the facility: On 5/21/2024, resident R1 was found at the neighborhood of the facility and Police was called. Police officers found R1 was wearing a bracelet which shows the address of the facility. R1 was brought back to the facility by the Police Officers. On 5/31/2024, LPA interviewed Administrator (ADM). ADM stated on 5/21/2024 morning, resident R1 was in and out the facility main entrance door. ADM stated staff S1 was accompanying with R1, and then S1 took R1 for walking to the near by park. Around 11:30AM, S1 brought R1 back to the facility and R1 took a break at the bedroom. ADM stated S1 started to prepare lunch. ADM stated around 12:30PM, police officers brought R1 back to the facility and the police officers stated R1 was found at the neighborhood. ADM stated he/she and staff did not hear the door alarm sounding. LPA checked the exit door of R1's bedroom, the alarm sounded when LPA and ADM opened the exit door of R1's bed room.. LPA interviewed resident R1. R1 can tell his/her name and DOB. R1 was unable to say what is the year today. R1 stated he/she likes to live in the facility. R1 cannot remember if he/she eloped from the facility recently. LPA interviewed resident R2. R2 was able to tell his/her name and DOB. R2 can tell what is the year today. R2 stated he/she knows a resident eloped from the facility recently, but he/she cannot remember what is the date and detail. LPA interviewed staff S1. S1 stated on 5/21/2024, around 11:00AM he/she took resident R1 to walk to the near by park. S1 stated around 11:30AM, he/she took R1 back to the facility and let R1 stay in the bedroom to take a break. S1 stated he/she then started to prepare the lunch. S1 stated R1 was brought back to the facility by police officers. S1 stated he/she checked R1's body and did not find any wound or bruise. S1 stated staff gave water and lunch to R1. S1 stated R1 is fine after back to normal. Continue on LIC9099-C. Page 2 of 3. LPA interviewed staff S2. S2 stated he/she was off when the incident occurred. S2 stated he/she knew the incident on the next day that R1 eloped from the facility. S2 stated during the incident, staff S1, another staff S3, Administrator and licensee were at the facility. S2 stated police officers brought R1 back to the facility. LPA interviewed licensee (LCN). LCN stated on 5/21/2024, he/she was working/cleaning at the backyard. LCN stated around 12:30PM the police officers brought R1 back to the facility. LPA reviewed R1's IPP dated 6/08/2023, page 5, it specifies R1 has a history of wandering/AWOL behavior. LPA reviewed R1's physician report dated 1/24/2024, it specifies R1's cognitive abilities are in a conditional state between normal aging and cognitive impairment, and R1 has history of AWOL. LPA reviewed R1's Appraisal/Needs and Services Plan dated 5/10/2024, it specifies R1 needs to desist from leaving the facility without notice at all times, day and night. R1 needs to be supervised at all time. Based on the interviews and records reviewed, the facility did not report R1's elopement incident to CCL office, the facility did not ensure resident R1 received supervision to meet R1's care need. The Department has investigated the above allegation. Based on documents reviewed, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED. Citations were noted today. Please see LIC9099-D. Appeal right was provided. Exit interview was conducted with ADM. A copy of the report was provide to ADM. Page 3 of 3.the state’s words, verbatim · CDSS document, Sep 17, 2024 · control 26-AS-20240523112616
From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Sep 24, 2024
87211 Reporting Requirements (a)(1)(D) Any incident which threatens the welfare, safety, or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews and records reviewed, Administrator did not send R1's elopement incident report to CCL office which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 17, 2024
Plan of correction: Administrator stated to submit plan of correction by the POC due date to ensure the facility to send incident reports to CCL office in timely manner.
From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 24, 2024
87468.1 Personal Rights (a)(2) Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interview and record review, Licensee did not provide the necessary care and supervision to meet R1's care needs, which resulted in R1's elopement from the facility, which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 17, 2024
Plan of correction: Administrator stated to submit a plan of correction by the POC due date to provide the training to staff to provide care and supervision to meet residents' needs and to provide the staff training log.
Apr 3, 2024Facility evaluation reportReport on file
Type of visit: Required - 1 Year
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced inspection visit, and met with Administrator (ADM) Mary Lazaro. LPA observed 3 staff and 3 residents in the facility, and 3 residents went out to the day program. LPA reviewed 3 resident files and 3 staff files. LPA toured the facility inside and out with ADM. License, Personal Rights posters and Administrator Certificate were observed posted at facility. Living room, kitchen, dinning room and two restrooms were inspected. Three shared resident bedrooms, and laundry room were inspected. Two staff live-in rooms and one small office were observed in facility. First Aid Kit, flash lights, and night lights were observed in the facility. Non-skid mats and bar were observed in restrooms Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 68 degree F, and hot water temperature was at 110 degree F in facility. Temperature of freezer was observed at 0 degree F, and temperature of refrigerator was observed 38 degree F. Fire extinguisher was serviced on 12/13/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. All the bed rooms were observed with screens. The last time the facility conducted the emergency drill was 4/1/2024. No citation noted for today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of report was provided to ADM.the state’s words, verbatim · CDSS document, Apr 3, 2024
What the state’s words mean
CDSS citation definitions (PDF) ↗ · CDSS complaint outcomes ↗
Life here
Rooms, meals, the rhythm of a day, faith and language, pets and house rules — as the home describes them. Tap any detail for its source and date; nothing here is graded.
The home has not described daily life anywhere we have reviewed yet — that is the case for most small homes, and it says nothing about the home. These questions fill in the picture; keep the ones that matter to you.
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Ask every home the same questions — the state’s record does not answer these. Keep the ones that matter and they travel with your saved homes.
- What is included in the monthly rate, and what costs extra?
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