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ICF/DD-N (Nursing)License activeMedi-Cal certified

TUPAZ HOME #11

ICF/DD-N (Nursing) · 6 licensed beds · San Jose, CA

Homes of 4–15 beds for medically fragile people with developmental disabilities who need intermittent skilled nursing.

Address

TUPAZ HOME #111850 POTRERO DRSan Jose, CA 95124 · Santa Clara County

Phone: (408) 266-2461

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-N (Nursing)
Licensed beds
6
Licensee
TUPAZ HOMES LLC · Limited Liability Company
Administrator
SAPIGAO, RONALD
CDPH facility ID
070001404
License number
070000681
Current license
Apr 21, 2025 to Apr 20, 2026
CDPH district office
San Jose

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G517
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
May 20, 2005
Last certification survey
August 8, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (proprietary)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.25 · LVN/LPN 1.5 · direct care 8.25 · all employees 10.75

State citations and penalties (CDPH)

1 penalty, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BPatient Care

    Citation B (HSC 1424) · Violation Sep 21, 2016 · Penalty #070012640 · Survey 9OZQ11

    Status: Closed · Not appealed

    $1,000

Federal inspections (CMS-2567)

21 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Complaint

    Event 2AA712-H1 · no deficiencies cited

    Official 2567 ↗
  2. · Complaint

    Event 25D695-H1 · no deficiencies cited

    Official 2567 ↗
  3. · Complaint

    Event 25C5AC-H1 · 1 deficiency

    Official 2567 ↗
  4. · Recertification

    Event BKV421 · 4 deficiencies

    Official 2567 ↗
  5. · Complaint, Recertification

    Event BKV411 · 13 deficiencies

    Official 2567 ↗
  6. · Complaint

    Event GHNT11 · 4 deficiencies

    Official 2567 ↗
  7. · Recertification

    Event X3ST21 · 2 deficiencies

    Official 2567 ↗
  8. · Complaint, Recertification

    Event X3ST11 · 8 deficiencies

    Official 2567 ↗
  9. · Complaint

    Event 2OR811 · no deficiencies cited

    Official 2567 ↗
  10. · Recertification

    Event WOEZ21 · 6 deficiencies

    Official 2567 ↗
  11. · Recertification

    Event WOEZ11 · 4 deficiencies

    Official 2567 ↗
  12. · Complaint

    Event YQKY11 · no deficiencies cited

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

22 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (complaint): no deficiencies(state record)

  2. ReportFederal survey (complaint): no deficiencies(state record)

  3. ReportFederal survey (complaint): 1 deficiency(state record)

  4. ReportFederal survey (recertification): 4 deficiencies(state record)

  5. ReportFederal survey (complaint, recertification): 13 deficiencies(state record)

  6. ReportFederal survey (complaint): 4 deficiencies(state record)

  7. ReportFederal survey (recertification): 2 deficiencies(state record)

  8. ReportFederal survey (complaint, recertification): 8 deficiencies(state record)

  9. ReportFederal survey (complaint): no deficiencies(state record)

  10. ReportFederal survey (recertification): 6 deficiencies(state record)

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.