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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 419210025
Report Date: 11/15/2023
Date Signed: 11/15/2023 02:01:32 PM

Document Has Been Signed on 11/15/2023 02:01 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FOCUS DAY PROGRAMFACILITY NUMBER:
419210025
ADMINISTRATOR:YOLANDA T. RUIZFACILITY TYPE:
775
ADDRESS:715 SAN MATEO AVE.TELEPHONE:
(650) 589-2948
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 75CENSUS: 0DATE:
11/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Program Director Willie RazTIME COMPLETED:
02:45 PM
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Licensing Program Analyst, Jason Lund arrived unannounced to conduct an annual/required inspection. When LPA Lund arrived at the day program and it was closed. LPA called and spoke with Program Director, William (Willie) Raz who stated that the facility has not been open since COVID 19 pandemic. Census: 0

LPA Lund & Program Director Willie Raz toured/inspected the facility. There are four activity rooms, three changing rooms and one hoyer lift available. There are two restrooms with four stalls each. Two first Aid kits and manual were present. Flashlights were operational. Three fire extinguishers, two pull alarm, sprinklers, smoke detectors, carbon monoxide detectors are all present on premises.

No deficiencies cited during this visit and report left.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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