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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430707864
Report Date: 06/23/2022
Date Signed: 06/23/2022 05:05:59 PM

Document Has Been Signed on 06/23/2022 05:05 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:LEARNING SERVICES-SOUTH VALLEY RANCH#2FACILITY NUMBER:
430707864
ADMINISTRATOR:SHREEVE, KAYREEFACILITY TYPE:
735
ADDRESS:10855 DE BRUIN WAYTELEPHONE:
(408) 848-4379
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 10CENSUS: 4DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Abraham LongoriaTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a required 1-year annual inspection to focus on infection control. LPA met with Administrator, Abraham Longoria.

During visit, LPA toured the Casa Castillo House to include the dining room, bathrooms, activity room, resident rooms, and exterior. Facility observed to have a designated entry point for COVID-19 symptoms screening located in the Therapy Center for all visitors and staff. All fire exit routes were free and clear of obstruction.

Bathrooms observed to be supplied with hygiene products, paper supplies, and hand washing signs. Hand sanitizer available throughout the facility. The following posters were observed to include: symptoms of COVID, social distancing, visitor policy, and help limit the spread of germs. Facility cleans and disinfect multiple times daily and as needed. Facility has a procedure in place for visitation. LPA observed supply of Personal Protective Equipment (PPE). All staff are vaccinated to include the booster. All staff observed to be wearing a mask. Staff are currently undergoing N95 fit testing.

Administrator has submitted the facility's infection control plan and is pending approval by CCLD.

No citations were issued per the California Code of Regulations, Title 22.

This report was reviewed with Abraham Longoria and a copy of this report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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