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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201773
Report Date: 03/20/2025
Date Signed: 03/20/2025 02:34:33 PM

Document Has Been Signed on 03/20/2025 02:34 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/
DIRECTOR:		HOMARA, MANIZHEHFACILITY TYPE:
775
ADDRESS:18980 MONTEREY ROADTELEPHONE:
(408) 778-5600
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 81CENSUS: 51DATE:
03/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Michelle VillarrealTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required 1 year annual inspection. LPA met with Administrator, Michelle Villarreal and Program Manager, Stephanie Valera.

During visit, LPA toured the day program to include the activity rooms, cafeteria, offices, hallway, and exterior. There are 6 sheds located in the backyard, all the sheds contained storage supplies. All fire exit routes and passageway were free and clear of obstruction. Sharp objects, medications, chemicals and disinfectants observed locked.

Fire extinguishers last serviced on 06/12/2024. Carbon monoxide detectors in the front and back building is in operating condition. Refrigerator temperature maintained at 40 degrees F. Freezer temperature maintained at 0 degrees F. Facility temperature maintained at 73 degrees F. Activity rooms observed clean and equipped with supplies.

Bathrooms equipped with hygiene products and paper supplies. LPA measured the hot water temperature in 3 bathrooms located the main (front) building. Hot water temperature was maintained between 85 - 87.8 degrees F. Hot water temperature in the back building measured at 118.7 degrees F.

LPA reviewed 5 resident files were complete. 3 out of 5 residents has their medications centrally stored at the day program. 3 resident's centrally stored medications and centrally stored medication records were reviewed and observed complete.

See LIC809-C.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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Document Has Been Signed on 03/20/2025 02:34 PM - It Cannot Be Edited


Created By: Christine Kabariti On 03/20/2025 at 02:03 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: 03/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above where in the hot water temperature in the front building was measured between 85 - 87.8 degrees F which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2025
Plan of Correction
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Licensee will adjust the hot water temperature in the front building and send a picture of the water temperature to LPA Kabariti via email 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:Jackie Jin
LICENSING EVALUATOR NAME:Christine Kabariti
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2025


LIC809 (FAS) - (06/04)
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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: 03/20/2025
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LPA reviewed 5 staff files were complete. Staff are provided annual training. Disaster drills are conducted quarterly and the last drill was completed on 12/2024.

Documents were obtained to include: LIC500 and LIC308.

A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Administrator, Michelle Villarreal and Program Manager, Stephanie Valera and a copy of the report and appeal rights was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC809 (FAS) - (06/04)
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