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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601021
Report Date: 11/06/2024
Date Signed: 11/06/2024 02:25:14 PM

Document Has Been Signed on 11/06/2024 02:25 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: 0DATE:
11/06/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:N/ATIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On November 6, 2024, Licensing Program Analysts (LPAs) Komal Charitra and Dominic Tobola conducted an unannounced collateral visit in order to deliver exclusion letter to staff person (S1) at his/her residence which is not at the facility.

LPAs hand delivered the exclusion letter addressed to S1 at his/her home address. LPAs knocked on the door, however no one opened the door. LPAs put the letter on S1's door that matches the address of S1. LPAs took photos of the letter on the door which displays the address number. LPAs forwarded photos to management as proof of delivery to the address.

LPAs did not meet anyone during this visit.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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