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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601108
Report Date: 08/01/2024
Date Signed: 08/01/2024 11:24:31 AM

Document Has Been Signed on 08/01/2024 11:24 AM - 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 PROGRAMFACILITY NUMBER:
415601108
ADMINISTRATOR/
DIRECTOR:		RUIZ, YOLANDA T.FACILITY TYPE:
775
ADDRESS:409 S SPRUCE AVENUETELEPHONE:
(650) 589-8630
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 75CENSUS: 40DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:46 AM
MET WITH:Yolanda Ruiz & Amy RamosTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 8/1/2024, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Yolanda Ruiz & HR Manager Amy Ramos. LPA explained the purpose of the visit.

LPA toured the facility including all of activity rooms, common areas & kitchen. This is a two story facility. The indoor and outdoor passageways were free of obstruction. LPA observed clients doing activities such as arts & crafts, dancing & music therapy. While touring the facility it was observed that the room temperature was at 70 deg F. Carbon monoxide monitors are working properly. Facility has a sprinkler system. All fire extinguishers have been checked and current. Client bathrooms were observed to be in good repair equipped with grab bars, and non-skid floors. Changing rooms are clean and odorless. Food are brought in by residents prepared from their home facilities. Medications was locked.

Five client records and five staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs.

LPA requested the following documents: LIC308, LIC500, Plan of Operation.

No deficiencies are cited at this time. Report is reviewed and a copy is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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