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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601021
Report Date: 09/03/2024
Date Signed: 09/03/2024 12:02:16 PM

Document Has Been Signed on 09/03/2024 12:02 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/
DIRECTOR:		MOCK, RYANFACILITY TYPE:
775
ADDRESS:355 GELLERT BLVD, STE 100TELEPHONE:
(510) 342-6046
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 60CENSUS: 27DATE:
09/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Adam Canon and Angie JacobTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On September 2, 2024, Licensing Program Analysts (LPAs) Kiran Jain and Grace Donato arrived at the facility at 08:50 AM to conduct the Annual 1-year required inspection. LPAs met with the Angie Jacob, Case Manager and Adam Canon, Behavioral Aide, and explained the purpose of the visit. LPAs were later joined by the Program Director Ryan Mock.

LPAs toured the physical plant. LPAs observed 5 rooms – store front, quite room, exercise room, art room, game/movie room, main common room to be clean and well-maintained. No accessible bodies of water or hazards were observed. Fire extinguishers were fully charged and last serviced on August 2024. Smoke detectors and carbon monoxide detectors were observed to be in working condition. Adequate lighting and comfortable indoor temperature were observed in the facility. Emergency exit routes are marked, and an emergency evacuation plan was posted in each room.

LPAs observed toxins, cleaning supplies, and sharp objects locked away in the storage/chemicals room and were inaccessible to the participants. No cooking or meal preparation was seen at the facility. Participants bring their own lunch/food, which they could warm in the microwave with the help of staff members. Kitchen use is primarily for staff members. The Refrigerator in the kitchen is used to store staff food. LPAs observed bathroom areas to be fully stocked with paper towels, hand soap, and a trash can. The bathroom faucet water temperature was measured at 112.8 °F.

Participants were observed sitting in the main common area, engaging in activities, exercising, and assisting with daily chores. LPAs reviewed 5 random participant files and 5 random staff files. All were observed to be complete. The client’s medications were securely stored in a locked cabinet. The First Aid kit was checked and found to have the required items. Emergency drills are conducted quarterly with the last drill documented on May, 2024.

No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Angie Jacob and Ryan Mock and a copy of this report was left at the facility.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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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