SeniorLivingFacts.com
Menu
Back

EVONNE'S RESIDENTIAL CARE HOME #1

2719 PENITENCIA CREEK RD., San Jose CA 95132

Facility 435202392 · RESIDENTIAL CARE ELDERLY (740)

7 bedsLatest official report May 7, 2026Licensed

Additional info
Licensee
PHILOMENA AGBONTAEN
Administrator
PHILOMENA AGBONTAEN
Contact
PHILOMENA AGBONTAEN
License first date
Feb 24, 2014
License effective date
Feb 24, 2014
District office
SAN JOSE RO · (408) 324-2112
Regional office
26
Clients served
935 - ELDERLY

Summary

The available records show 7 Type B deficiencies for this facility.

Most recent inspection
Feb 25, 2026
Most recent deficiency
Feb 25, 2026

1 later report, on May 7, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.

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 11 Santa Clara County facilities licensed for 7 to 15 beds, except where too few exist to state one — those come from facilities with 7 or more beds.

In the available public five-year record, CCLD published 10 reports for this facility: 7 inspections, 1 complaint investigation, and 2 licensing or administrative records.

Those records contain 0 Type A and 7 Type B deficiencies.

0 deficiencies have explicit official correction or clearance evidence in the loaded records.

Official inspections
7

Fewer than the typical 8

2 in the last 12 months

Recorded deficiencies
7

More than the typical 3

3 in the last 12 months

Type A deficiencies
0

Fewer than the typical 2

0 in the last 12 months

Type B deficiencies
7

Well above the typical 1

3 in the last 12 months

Substantiated complaints
0

Most this size also have none

0 in the last 12 months

Repeated topics
0

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.

No topic repeats in the last 36 months

No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.

Official report history

All preserved reports from the most recent to the oldest, sortable by report type.

Inspection
All report typesInspectionComplaintLicensing record
Inspection
Medication handling and storageType B
Official classification
Type B
Official code
87465(h)(2)
Regulation authority
CCR

What the official deficiency says

(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 Based on observation, the licensee did not comply with the section cited above. LPA observed an unsecured half orange tablet on the kitchen table. S1 stated he/she had forgotten to put the medication tablet back. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2026 Plan of Correction ADM secured medication during visit. ADM stated she will send letter of understanding regarding the regulation. ADM stated she will send the Plan of correction by POC due date, March 4, 2026.

Corrective action observedRecorded in report dated Feb 25, 2026
Plan of correction recorded
View official report
Admission, assessment, and evictionType B
Official classification
Type B
Official code
87463(a)
Regulation authority
CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 reviewed facility records for 3 residents. LPA observed 3 Out of 3 resident (R1-R3) Needs and services plans were not updated. ADM stated she has not had the chance to update them. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2026 Plan of Correction ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send a copy of R1-R3's updated needs and services plan to LPA by POC due date, March 4, 2026.

Plan of correction recorded
Correction not verified in available records
View official report
Medication handling and storageType B
Official classification
Type B
Official code
87465(h)(6)
Regulation authority
CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: 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 residents had medications that were not listed on their centrally stored medication record. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2026 Plan of Correction ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send a copy of R1-R3's updated Centrally stored medication Record.

Plan of correction recorded
Correction not verified in available records
View official report
View official source
Inspection
Staffing, personnel, and trainingType B
Official classification
Type B
Official code
87412(a)
Regulation authority
CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and record review, the licensee did not comply with the section cited above by not having complete staff files missing required documents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2025 Plan of Correction Designated Administrator stated they will submit a letter of understanding regarding regulation and will submit by POC date 02/21/25 via email to LPA.

Plan of correction recorded
Correction not verified in available records
View official report
View official source
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 interview, the licensee did not comply with the section cited above. LPA requested to review residents weight record log. ADM stated she doesn't have a log for the residents weights. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2024 Plan of Correction ADM stated she will send a plan of action on how the facility will maintian a weight record log for the residents. ADM stated she will send plan of action, by POC date, 02/21/2024.

Plan of correction recorded
Correction not verified in available records
View official report
Fire safety and emergency preparednessType B
Official classification
Type B
Official code
1569.695(c)
Regulation authority
HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. The facility's last drill was on September 2, 2023. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2024 Plan of Correction ADM stated she will conduct a fire/earthquake drill and send documentation that a drill has taken place to LPA by POC date, 02/21/2024.

Plan of correction recorded
Correction not verified in available records
View official report
Dementia careType B
Official classification
Type B
Official code
87705(c)(5)
Regulation authority
CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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. LPA reviewed R1's facility file. R1's physicians report states R1 has dementia. R1's most current physicians report is dated September 6, 2022. ADM confirmed the physicians report had not been updated. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2024 Plan of Correction ADM stated she will send plan of action on how the facility will ensure Each resident with dementia shall have an annual medical assessment and a reappraisal done at least annually. ADM stated she will send plan of action to LPA by POC date, 02/21/2024.

Plan of correction recorded
Correction not verified in available records
View official report
View official source

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