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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202031
Report Date: 06/29/2022
Date Signed: 06/30/2022 08:25:30 AM

Document Has Been Signed on 06/30/2022 08:25 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:PIEDMONT ADULT DAY PROGRAM (PADPRO)FACILITY NUMBER:
435202031
ADMINISTRATOR:RANULFO DIEGO GARCIAFACILITY TYPE:
775
ADDRESS:1325-1333 PIEDMONT RD #109-110TELEPHONE:
(408) 347-0402
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY: 75CENSUS: 69DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Ranulfo GarciaTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit today, and met with Executive Director (ED) Ranulfo Garcia.

Upon arrival, Front desk staff took LPA temperature, and logged LPA in the visitor log book. LPA observed the COVID posters at the main Entrance. LPA toured the whole facility with ED.

LPA observed the COVID posters in facility. LPA observed all the staff were wearing masks. LPA observed not all the clients were wearing masks. 2 offices, 5 activity rooms, 1 library, 1 multi function hall, 1 Arts and Craft room, 5 restrooms, 1 kitchen, and 1 Lounge were observed and inspected. All the trash can were observed with covers. Two restrooms were observed without paper towels with holders. ED put the paper towels with holders in the two restrooms before LPA left facility. There were signage of washing hands for 20 seconds by the sinks in restrooms and kitchen. .

The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Fire extinguishers were observed serviced on 2/28/2022.


Exit interview was conducted with ED, No citation was noted for today visit. This report was provided to ED for signature.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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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