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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707115
Report Date: 01/24/2023
Date Signed: 01/24/2023 10:52:57 AM

Document Has Been Signed on 01/24/2023 10:52 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:LEARNING SERVICES - SOUTH VALLEY RANCH #1FACILITY NUMBER:
430707115
ADMINISTRATOR:ABRAHAM LONGORIAFACILITY TYPE:
735
ADDRESS:10855 DEBRUIN WAYTELEPHONE:
(408) 848-4379
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 18CENSUS: 10DATE:
01/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Abraham LongoriaTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Administrator, Abraham Longoria.

During visit, LPA toured the Becker House to include the kitchen, dining room, medication room, activity room, resident rooms, and bathrooms. All fire routes were free and clear of obstruction. Toxins were observed secured. Facility temperature was maintained between 66 to 72 degrees Fahrenheit. All staff presents are fingerprint cleared and associated to the facility. All staff observed wearing a face mask.

Facility has a designated entry point for COVID-19 symptom screening, temperature check, and sign-in for all visitors, staff, and residents located in the Therapy Center. LPA observed hand sanitizer made available and lidded trash bins throughout the facility. Bathrooms supplied with paper supplies, hygiene products, and hand washing sign. Facility has sufficient Personal Protective Equipment (PPE) supplies. Staff are N95 fit tested. Facility staff clean and disinfect multiple times daily. LPA observed staff's training records to infection control that was conducted in October 2022. LPA reviewed the facility's policies and procedures to visitation, isolation, and testing for COVID-19. The following posters observed to include symptoms of COVID, social distancing, and visitation guidelines. LPA advised to place a hand washing sign next to all sink areas and to post their infection control plan in a visible location.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Abraham Longoria and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023
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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