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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201947
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:42:16 PM

Document Has Been Signed on 06/23/2022 03:42 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:MULTIPLE INTELLIGENCE TRAINING CENTERFACILITY NUMBER:
435201947
ADMINISTRATOR:AURORA MENDOZAFACILITY TYPE:
775
ADDRESS:3737 MADELINE DRIVETELEPHONE:
(408) 254-9241
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 90CENSUS: 85DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mary Jane BanagaTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit today, and met with Manager of Operation (MO) Mary Jane Banaga.

Upon arrival, MO took LPA temperature, and logged LPA in the visitor log book. LPA observed the COVID posters on the main door. LPA toured the whole facility with MO.

LPA observed the COVID posters in facility. LPA observed all the staff were wearing masks. LPA observed not all the clients were wearing masks. 1 offices, 4 classrooms, 6 restrooms, 1 kitchens were observed and inspected. All the trash can were observed with covers except those in the restrooms. MO stated the facility will change the trash cans in restrooms to trash cans with covers in 5 day. There were no signage of washing hands for 20 seconds by the sinks in restrooms and kitchen. MO stated the facility will put the signages of washing hands for 20 seconds on in 5 days. Two isolation rooms were observed in facility.

Fire extinguishers were observed serviced on 4/30/2022. LPA suggested MO to put more hand sanitizers at common area..


Exit interview was conducted with MO, No citation was noted for today visit. This report was provided to MO for signature.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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