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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201773
Report Date: 04/26/2023
Date Signed: 04/26/2023 01:21:08 PM

Document Has Been Signed on 04/26/2023 01:21 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: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: 37DATE:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle Villarreal TIME COMPLETED:
01:25 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Christine Dolores and Grace Donato arrived unannounced to conduct the facility's annual inspection. LPAs met with Training Coordinator Jhanelle Guico, Office Manager, Remedios Bose, and Program Director Michelle Villarreal.

During visit, LPAs toured the day program to include the activity rooms, cafeteria, offices, hallway, and exterior. Fire exit routes and passageway were free and clear of obstruction. Fire extinguishers last serviced on 06/29/2022. Carbon monoxide detector is in operating condition. Inside temperature maintained at 67 - 70 degrees Fahrenheit.

LPAs observed four transportation vehicles whose registrations were up-to-date. The transportation vehicles contained a fire hydrant, disinfectant solutions, and first aid kit.

Activity rooms observed clean and equipped with supplies. Cafeteria supplied with multiple snacks, clean water and cups for drinking. Bathrooms equipped with hand washing signs, hygiene products, and paper supplies. Hot water temperature in the bathroom was maintained at 98.7 degrees Fahrenheit. Based on interview, the water heater recently broke down during the winter storm. During visit, staff purchased a new water heater tank and verbalized plans to install the new water heater tank.

LPAs observed more than ten long planks of wood about 5-6 feet long near the exit route of the cafeteria. The area was accessible to clients in care. The long planks of wood contained multiple nails that stuck out of the wood. Facility staff immediately relocated the planks of wood to a secured area. Program Director states the planks of wood were from a fallen fence due to the winter storms. The Program Director is working with the neighbor to repair the fence. LPA observed the fence was temporarily secured using tarps. SEE LIC809-C.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: MMS BEHAVIORAL DAY PROGRAM, INC.
FACILITY NUMBER: 435201773
VISIT DATE: 04/26/2023
NARRATIVE
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LPAs reviewed 5 clients files to contain admission agreements, appraisal needs and services plans, physicians report, and TB information. LPAs observed 3 out of 5 clients admission agreements were not signed and 2 out of 5 clients appraisal needs and services plans were not up-to-date for the year. Program Director was advised.

LPAs reviewed 4 staff files to contain a health screening report, TB information, 1st aid certification, and training records. LPAs observed the staff were not provided at least 8 hours of training for the year. Program Director states the staff have been provided training, however, the training were not documented. Program Director was advised. LPA observed the day program's emergency drill was last conducted on 01/06/2023.

Posters and signs observed throughout the program includes facility license, emergency disaster plan, if you see something say something, grievance policy, hand washing, and COVID-19 related signs.

LPAs interviewed 4 clients and 4 staff members.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Advisory notes provided. This report was reviewed with Program Director, Michelle Villarreal and a copy of the report and appeal rights was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 04/26/2023 01:21 PM - It Cannot Be Edited


Created By: Christine Dolores On 04/26/2023 at 12:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MMS BEHAVIORAL DAY PROGRAM, INC.
FACILITY NUMBER: 435201773

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, there were more than ten long planks of wood about 5-6 feet long near the exit route of the cafeteria which contained nails and was accessible to clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2023
Plan of Correction
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Staff immediately secured the long planks of wood. Staff will ensure all items that can pose a danger if readily available will be kept inaccessible. Licensee will submit a statement of understanding of the section cited above to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sarah Yip
LICENSING EVALUATOR NAME:Christine Dolores
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 04/26/2023 01:21 PM - It Cannot Be Edited


Created By: Christine Dolores On 04/26/2023 at 12:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MMS BEHAVIORAL DAY PROGRAM, INC.
FACILITY NUMBER: 435201773

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065.1(d)(1)
Personnel Qualifications and Duties
(1) Direct care staff shall receive a minimum of 8 hours a year of training, documented.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review the facility did not document a minimum of 8 hours a year of training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2023
Plan of Correction
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Licensee will submit their plan to ensure staff are receiving a minumum of 8 hours of training a year to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sarah Yip
LICENSING EVALUATOR NAME:Christine Dolores
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023


LIC809 (FAS) - (06/04)
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