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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201773
Report Date: 03/10/2022
Date Signed: 03/10/2022 12:19:09 PM

Document Has Been Signed on 03/10/2022 12:19 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:MMS BEHAVIORAL DAY PROGRAM, INC.FACILITY NUMBER:
435201773
ADMINISTRATOR:HOMARA, MANIZHEHFACILITY TYPE:
775
ADDRESS:18980 MONTEREY ROADTELEPHONE:
(408) 778-5600
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 81CENSUS: 10DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Michelle VillarrealTIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Christine Dolores conducted an unannounced Required - 1 Year annual inspection to include Infection Control site visit and met with Administrator Michelle Villarreal. Day Program is conducting virtual program and open in-person Monday through Friday from 8:30 a.m. - 2:00 p.m..

LPA toured the facility inside and outside to include the central entry point, activity rooms, restrooms, isolation room and backyard. All staff observed to be wearing a mask. Client's participating in activities were observed socially distanced. Each activity room supplied with hand sanitizer, surgical masks, and gloves. All fire exit routes were free and clear of obstructions.

Facility has a designated entry point for COVID-19 symptom screening for clients, staff, and visitors. Bathrooms observed to be supplied with hygiene products, paper supplies, and hand washing signs. Facility has foot operated trash cans with lids. LPA observed supply of Personal Protective Equipment (PPE). Facility is cleaning and disinfecting multiple times daily and as needed. The following signs were observed to include social distancing, required mask, stop the spread of germs, and feeling sick.

LPA requested Administrator to send facility's LIC-500 and LIC-610D 03/11/2022.

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

This report was reviewed with Administrator Michelle Villarreal and a copy of this report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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