Basic services and supervision
Cited in 2 reports, with 2 deficiencies in total.
ANGELS SENIOR CARE HOME
4078 FREED AVENUE, San Jose CA 95117
6 bedsLatest official report Jan 14, 2026Licensed
Additional info
- Telephone
- (408) 244-7689
- Licensee
- ANGELS SENIOR CARE HOME, LLC
- Administrator
- LUO, XI-HUA
- Contact
- LUO, XI-HUA
- License first date
- Jan 4, 2006
- License effective date
- Jan 4, 2006
- District office
- SAN JOSE RO · (408) 324-2112
- Regional office
- 26
- Clients served
- 935 - ELDERLY
Summary
The available records show 3 Type A and 7 Type B deficiencies for this facility.
- Most recent inspection
- Jan 14, 2026
- Most recent deficiency
- Jan 14, 2026
No later report is available, so the records do not show what happened afterward.
What Type A and Type B mean
- Type A
- 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
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 185 Santa Clara County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 8 reports for this facility: 7 inspections, 1 complaint investigation, and 0 licensing or administrative records.
Those records contain 3 Type A and 7 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 7
- Recorded deficiencies
- 10
- Type A deficiencies
- 3
- Type B deficiencies
- 7
- Substantiated complaints
- 0
- Repeated topics
- 3
More than the typical 5
1 in the last 12 months
Well above the typical 3
1 in the last 12 months
More than the typical 1
1 in the last 12 months
Well above the typical 2
0 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Fire safety and emergency preparedness
Cited in 2 reports, with 2 deficiencies in total.
Hazardous items and storage
Cited in 2 reports, with 2 deficiencies in total.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(h)(2)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement During facility tour, LPAs observed the following medications to be stored in the kitchen refrigerator without being inside a locked container: Medications M1-M4 (belonging to R1), and Medication M5 (belonging to R2), which poses an immediate safety risk to residents in care.
Official plan of correction
POC Due Date: 01/15/2026 Plan of Correction Licensee agrees to submit a plan of correction by 01/15/2026 stating how the licensee shall ensure that all centrally stored medications, including those requiring refrigeration, are kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Licensee agrees to submit photographic evidence of refrigerated medications stored in locked containers. Licensee agreed and understood.
Plan of correction recorded
Correction not verified in available records
Inspection
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87307(a)
- Regulation authority
- CCR
What the official deficiency says
Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by allowing staff to use shed as a living space which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 01/10/2025 Plan of Correction LIcensee will return shed to purpose of storing material items rather than a living space for staff and provide pictures of correction.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87303(e)(2)
- Regulation authority
- CCR
What the official deficiency says
Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in which water temperature was observed at 149.0 degrees F which is not within limits and poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 01/10/2025 Plan of Correction Licensee adjusted water temperature during inspection and adjusted temperature was observed at 105.0 Degrees F. Licensee will maintain a water tempurature log to document and ensure water temperatures remain within safe levels.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Inspection
No deficiencies recorded in this report
Complaint
Allegations0 substantiated · 3 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportInspection
Basic services and supervisionType B
- Official classification
- Type B
- Official code
- 87466
- Regulation authority
- CCR
What the official deficiency says
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above. LPA requested weight record for residents. ADM stated she used to do weigh the residents, but because they have trouble standing up, she doesn't have a weight record for those residents. The facility did not provide weight records for R1-R3. which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 02/03/2024 Plan of Correction ADM stated she will send plan of action on how the facility will maintain a weight records for her residents, to observe changes in weight. ADM stated she will send plan of action to LPA by POC date, 2/03/2024.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 87202(a)
- Regulation authority
- CCR
What the official deficiency says
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interviews, the licensee did not comply with the section cited above. ADM, S1 and S2 confirmed that staff were sleeping in the storage units in the backyard. This poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 02/28/2024 Plan of Correction ADM stated he/she will send plan of action regarding staff sleeping in the backyard sheds. ADM stated he will send his/her written plan of action by POC date, February 28, 2024.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType B
- Official classification
- Type B
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation, LPA observed two cans of paint in the backside of the shed acessible to residents in care. This poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 02/03/2024 Plan of Correction ADM stated she will send a plan of action on how she will ensure cleaning solutions and other items that could pose a danger is not acessible to residents in care. ADM stated she will send plan of action by poc date.
Plan of correction recorded
Correction not verified in available records
Licensing and administrationType B
- Official classification
- Type B
- Official code
- 87207
- Regulation authority
- CCR
What the official deficiency says
87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above. While reviewing R3's medication records, one of R3's medications was two pills short, when cross referencing the medication start date and the Medication administration record. ADM asked S3 what had occurred. S3 stated she did not know.this poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 02/03/2024 Plan of Correction Administrator will submit a written plan on understanding regulations and schedule in-services and training to staff by POC date. Administrator agreed and understood.
Plan of correction recorded
Correction not verified in available records
Inspection
Basic services and supervisionType B
- Official classification
- Type B
- Official code
- 87466
- Regulation authority
- CCR
What the official deficiency says
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above. 3 out of 3 resident files reviewed do not have a weight record. ADM stated because residents have trouble standing up, she doesn't have a weight record for those residents. This poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 02/03/2024 Plan of Correction ADM stated she will send plan of action on how the facility will maintain a weight records for her residents, to observe changes in weight. ADM stated she will send plan of action to LPA by POC date, 2/03/2024.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 87202(a)
- Regulation authority
- CCR
What the official deficiency says
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. LPA observed two sheds in the backyard. S1 confirmed he/she sleeps in the shed across from the sun room. S2 stated the other shed is his/her bedroom. ADM confirmed S1 sleeps in the shed. This poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 02/03/2024 Plan of Correction ADM will send photo documentation showing the storage area is no longer being used as a sleeping area. ADM stated she will also send a letter of understanding stating no staff or any individual is allowed to sleep in the following areas without building permit and fire clearance such as but not limited to; the sheds, living room, and garage.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType B
- Official classification
- Type B
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation, LPA observed two cans of paint in the backside of the shed accessible to residents in care. This poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 02/03/2024 Plan of Correction ADM stated she will send a plan of action on how she will ensure cleaning solutions and other items that could pose a danger is not accessible to residents in care. ADM stated she will send plan of action by poc date. (This a report is a duplicate that was created erroneously. )
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
Read the data methodology