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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601021
Report Date: 12/15/2023
Date Signed: 12/15/2023 12:29:06 PM

Document Has Been Signed on 12/15/2023 12:29 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:STRIDES INCLUSION CENTERFACILITY NUMBER:
415601021
ADMINISTRATOR:MOCK, RYANFACILITY TYPE:
775
ADDRESS:355 GELLERT BLVD, STE 100TELEPHONE:
(510) 342-6046
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 60CENSUS: 30DATE:
12/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Ryan MockTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the Day Program to conduct an annual required inspection. LPA met with facility staff, and explained the purpose of the visit. LPA was later met by Administrator Ryan Mock.

LPA Valerio and Facility Staff took a tour of the facility to ensure compliance with Title 22 regulations. LPA observed common areas, activity rooms, and office space to be clean and free from debris. LPA observed toxins, cleaning supplies, and sharps locked away and inaccessible to participants. Participants were observed sitting in the main area, engaging in activities, exercising, and assisting with daily chores. LPA observed bathroom areas to be fully stocked with paper towels, soap, toilet paper, and a trash can. Hand sanitizer was also observed in areas of the programs. LPA observed fire extinguisher to be fully charged with it's last annual inspection on 11/28/2023. Carbon Monoxide detectors, fire pull alarm system, and fire detectors were observed to be in working condition.

LPA Valerio spoke to participants and staff during the visit. LPA reviewed 3 random participant files and 3 random staff files. LPA observed staff files to be current with required training. All resident files were up to date with current information.

LPA requested the following documentation be sent to the San Bruno Regional Office: LIC 500, Proof of Control of Property, LIC 308, LIC 610D, Infection Control Plan

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 3, no deficiencies were cited today.

An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
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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