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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601021
Report Date: 01/09/2024
Date Signed: 01/09/2024 05:14:41 PM

Document Has Been Signed on 01/09/2024 05:14 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:
01/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Matthew CanonTIME COMPLETED:
01:30 PM
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On 1/9/24 Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit. LPA met with Licensee Matthew Canon. LPA explained the purpose of today's visit.

LPA delivered an immediate exclusion letter to exclude a staff who worked in the facility before. Staff has not been working in the facility since November 27, 2023.

The letter was given to and reviewed by the Licensee.

This report is reviewed and discussed, and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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