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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 419210011
Report Date: 08/30/2023
Date Signed: 08/30/2023 05:38:35 PM

Document Has Been Signed on 08/30/2023 05:38 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SOCIAL DYNAMICS, A LIFE STEPS FOUNDATION.INC.PROGFACILITY NUMBER:
419210011
ADMINISTRATOR:ALAIN GREGORIOFACILITY TYPE:
775
ADDRESS:828C MAHLER ROADTELEPHONE:
(650) 259-1808
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 69CENSUS: 30DATE:
08/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator, Alain GregorioTIME COMPLETED:
02:00 PM
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On August 30, 2023 Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by administrator, Alain Gregorio. LPA explained the purpose of the visit.

LPA toured facility with Alain. This day program consists of an exercise/gym room, a sensory/music room, and arts/crafts room; cubicles for small group activities. There is a kitchen/break room; clients bring their own lunch from home. Facility only provide water to clients. Facility does not handle medications or clients monies. There are two restrooms, one for men, and one for women with multiple stalls in each restroom. Hot water in the bathrooms are measured at 109-118 degrees F. Fire extinguisher was last inspected on 9/14/2022.

5 staff records were reviewed and contained criminal clearance, first aid / CPR certificate, Job Description, Abuse Statement, Health Screening with TB test result, etc.

Emergency drills are conducted quarterly- latest drills were conducted on Jan 17, 2023, April 12, 2023 and July 14, 2023 (Active Shooter).

LPA will return on another day to complete the inspection.

No deficiency cited today.

This report is reviewed and discussed with administrator.

A copy is provided.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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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