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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201399
Report Date: 08/25/2021
Date Signed: 08/25/2021 01:37:22 PM

Document Has Been Signed on 08/25/2021 01:37 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:W.A.T.C.INCORPORATED(WREN AVENUE TRAINING CENTER)FACILITY NUMBER:
435201399
ADMINISTRATOR:ZIPAGAN, SANDYFACILITY TYPE:
775
ADDRESS:7888 WREN AVE. BLDG A-111TELEPHONE:
(408) 472-2059
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 30CENSUS: 28DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Pony TuazonTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Christine Dolores and Marybeth Donovan conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Pony Tuazon, Assistant Administrator. LPAs observed no clients on site. The facility has 28 clients participating in the day program. The day program operates 5 days a week; 3 out of 5 days are community based activities to include walking, exercise, dining, and shopping. 2 out of 5 days consist of virtual activities supported by home staff. The facility provides transportation services. All clients are screened at the time of pick-up.

LPAs toured the facility inside and out to include the entry, activity room, office, quiet room, isolation room, changing room, kitchen, and building shared bathroom. All fire exit routes were free and clear of obstructions. Facility does not administer medications. Toxins, cleaning supplies and sharp objects are secured.

Facility observed to have designated entry point for COVID 19 symptom screening. Bathrooms observed to be supplied with hygiene products. Hand sanitizer available to clients. LPAs observed supply of Personal Protective Equipment (PPE). COVID signs posted throughout facility. Donning and Doffing PPE sign posted next to isolation room.

LPAs reviewed the facility policies and procedures to include screening, isolation, disinfecting, staffing, training, PPE usage and social distancing.

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

LPAs reviewed report with Pony Tuazon, Assistant Administrator and Sandy Zipagan, Administrator and a copy provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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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