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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600982
Report Date: 09/15/2022
Date Signed: 09/15/2022 10:23:29 AM

Document Has Been Signed on 09/15/2022 10:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FOCUS DAY PROGRAM IIFACILITY NUMBER:
415600982
ADMINISTRATOR:RUIZ, YOLANDAFACILITY TYPE:
775
ADDRESS:575 PRICE AVENUETELEPHONE:
(650) 362-3990
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 60CENSUS: 17DATE:
09/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Program Manager, Maria VillacortaTIME COMPLETED:
10:35 AM
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On September 12, 2022, Licensing Program Analyst (LPA) Komal Charitra attempted to conduct an unannounced annual inspection however, the facility appeared to be closed for the day. LPA contacted, H/R and Administrative Assistant, Amelia Ramos and it was indicated that the Day Program closes at 12pm on Mondays, Wednesdays, and Fridays.

On September 15, 2022, LPA Charitra re-attempted to conduct the unannounced annual inspection at the day program. LPA met with Program Manager, Maria Villacorta and explained the purpose of the visit. LPA observed the screening log documentation for staff and visitors and Program Manager was able to provide screening log documentation for residents.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are present: entry procedures, daily monitoring for residents and staff, 30-day PPE supply, face coverings, COVID signage throughout the facility, and social distancing. There are 4 bathrooms in the facility and all were observed to be equipped with paper towels, liquid soap, and hand washing signs, however not all the bathrooms were equipped with a trash can with a fitted lid. LPA advised Program Manager to ensure all bathrooms have a trash can with a fitted lid. During the tour LPA observed all staff present with a face mask, and maintaining social distancing.

LPA toured and observed the 5 activity rooms at the facility to be clear from any tripping hazards. The kitchen was observed to be locked and inaccessible to clients in care. According to the Program Manager, clients do not have access to the kitchen, however they are able to utilize the refrigerator to store their lunches. There are no medications present at the facility because there are currently no clients at the facility that takes medication.

30-day PPE supply was observed in the office room. A comfortable temperature of 73 degrees F is maintained and lighting is sufficient for comfort. Overall, the facility is odor free and in good repair. First aid kit was present and completed. Changing room and staff break room was observed to be clean. Library room and spa room was observed to be spacious and in good repair.

LPA requests the following forms to be submitted to CCLD by 9/22/22:
-LIC308 Designation of Administrative Responsibility
-LIC500 Personnel Report
-Administrator Certificate
-Copy of Lease
-LIC610D Emergency Disaster Plan

No citations issued during the visit. LPA reviewed report with Program Manager, Maria Villacorta and a copy is provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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