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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201947
Report Date: 06/20/2024
Date Signed: 06/20/2024 04:36:49 PM

Document Has Been Signed on 06/20/2024 04:36 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/
DIRECTOR:		MARY JANE BANAGAFACILITY TYPE:
775
ADDRESS:3737 MADELINE DRIVETELEPHONE:
(408) 254-9241
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 90CENSUS: 89DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Mary Jane BanagaTIME VISIT/
INSPECTION COMPLETED:
11:59 AM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit today, and met with Program Director (PD) Mary Jane Banaga.

License and personal rights posters were observed in the facility.

PD stated there are 69 clients in the facility and 12 in virtual. There are 30 staff in the facility.

LPA requested client roaster and staff roaster.

5 client files and 5 staff files were reviewed. LPA interviewed 5 clients and 5 staff.

Offices, 3 activity rooms, 1 training room, 4 restrooms, 1 kitchens were observed and inspected. One isolation room was observed in facility. Room temperature was at 72 degree F, and hot water temperature was at 108 degree F in facility.

Fire extinguishers were observed serviced on 3/19/2024. The facility is equipped with fire alarm system. Carbon monoxide detectors were installed in the facility and were tested fine. First aid box, flash lights were observed in the facility.

The last time the facility conducted the emergency drill is 1/25/2024. Front yard and backyard were inspected. There was no obstruction to block the walkways.

Exit interview was conducted with PD. The report was provided to PD for signature. A copy of the report was provided to PD.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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