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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600982
Report Date: 01/28/2025
Date Signed: 01/28/2025 01:33:49 PM

Document Has Been Signed on 01/28/2025 01:33 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: 58DATE:
01/28/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Program Director, Maria Villacorta TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On January 28, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit. LPA met with Program Director, Maria Villacorta and explained the purpose of the visit.

The purpose of today's visit is to deliver an immediate exclusion letter to exclude Staff #1 (S1) from the facility.

The letter was given to the Program Director.

This report is reviewed and discussed with the Program Director and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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