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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600982
Report Date: 12/03/2024
Date Signed: 12/03/2024 01:44:15 PM

Document Has Been Signed on 12/03/2024 01:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FOCUS DAY PROGRAM IIFACILITY NUMBER:
415600982
ADMINISTRATOR/
DIRECTOR:		RUIZ, YOLANDAFACILITY TYPE:
775
ADDRESS:575 PRICE AVENUETELEPHONE:
(650) 362-3990
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 60CENSUS: 60DATE:
12/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Program Director, Maria VillacortaTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On December 3, 2024, Licensing Program Analyst (LPA) Komal Charitra and conducted an unannounced case management visit. LPA met with Program Director, Maria Villacorta and explained the purpose of the visit.

It was reported by the State Official that Staff 1 (S1) is not fingerprint cleared and/or associated to the facility. S1 was observed assisting clients in care.

During the visit, LPA reviewed S1's file and observed S1 to be fingerprint cleared and associated to the facility. According to the Program Director, S1 is a caregiver and a driver.

No citations are issued during the visit. Report is reviewed with Program Director and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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