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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707808
Report Date: 04/25/2024
Date Signed: 04/25/2024 12:33:33 PM

Document Has Been Signed on 04/25/2024 12:33 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:HOPE REHABILITATION SERVICES - PARKMOORFACILITY NUMBER:
430707808
ADMINISTRATOR/
DIRECTOR:		JUAN GUELFACILITY TYPE:
775
ADDRESS:1555 PARKMOOR AVENUETELEPHONE:
(408) 282-0449
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 60CENSUS: 25DATE:
04/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual required 1 - year inspection. LPA met with Program Manager (PM), Nga Au.

LPA toured the day program with PM to include the activity room, kitchen, bathroom, and storage closet. Participants observed participating in day program. All fire exit routes were free and clear of obstruction. All staff present are fingerprint cleared and associated to the facility. Fire extinguisher last serviced on 01/2024. Facility has carbon monoxide detectors present. Upon entrance, there is a sign in sheet for visitors. Posters observed to include but not limited to include personal rights, grievance, and if you see something say something. LPA observed all the participants lunch bags are stored inside a cabinet. Chemical, disinfectants, medications and sharp objects observed secured. Facility has a medication log for participants who require medication during program. Facility has a complete first aid kit. Kitchen hot water temperature maintained at 106 degrees Fahrenheit. Men and woman restrooms observed well-kept with hygiene products, paper supplies, and lidded trash bins. Facility has an infection control plan. LPA observed Personal Protective Equipment (PPE) supplies to include gowns, shields, masks, gloves, and hand sanitizer. Facility has an emergency disaster plan and emergency lighting. LPA observed 5 participants files are maintained to include an admission agreement, medical assessment, TB result, appraisal/needs and services plan or IPP, consent form, emergency information, and personal rights. LPA interviewed 5 participants. LPA observed 4 staff files are maintained to include 1st aid certification, fingerprint clearance, personnel record, health screening, TB result, and employee rights. 4 staff member's training records and the program manager's training records were reviewed. LPA interviewed 4 staff members.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Nga Au and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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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