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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201933
Report Date: 05/02/2024
Date Signed: 05/02/2024 11:58:19 AM

Document Has Been Signed on 05/02/2024 11:58 AM - 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:HOPE SERVICES-LAS COLINAS ADULT DAY PROGRAMSFACILITY NUMBER:
435201933
ADMINISTRATOR/
DIRECTOR:		CAROLYN JEAN FILIATRAULTFACILITY TYPE:
775
ADDRESS:30 LAS COLINAS LANETELEPHONE:
(408) 284-2850
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 55CENSUS: 27DATE:
05/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Program Manager, Lauro CentenoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst Simi Rai conducted an unannounced Required 1 Year visit and met with Program Manager (PM) Lauro Centeno. LPA observed 7 staff and 27 residents in the activity room of the facility.

During visit, LPA toured the facility inside and out. Sharps and medications were locked in secured areas.
The facility restrooms had available soap, paper towels and hand sanitizer. Hot water temperature in the bathroom sink was measured range of 114.8 degrees F - 115.0 degrees F. Exercise equipment was also observed. Refrigerators were available to store clients' food in the kitchen area. Hot water temperature in the kitchen sink was measured at 115.9 degrees F.

Fire extinguisher was observed and inspected on 01/5/2024. Facility smoke detectors and carbon monoxide detectors were in working condition. First aid kits were inspected and observed compliant with required regulations. The last disaster drill was conducted on 1/2/2024.

LPA Rai reviewed facility records for 5 staff and 5 clients. LPA Rai reviewed resident medications and central stored medication records. Client's medication kept in locked box in office.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Program Manager (PM) Lauro Centeno and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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