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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202031
Report Date: 06/27/2023
Date Signed: 06/27/2023 01:04:52 PM

Document Has Been Signed on 06/27/2023 01:04 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: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: 64DATE:
06/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:executive director Ranulfo GarciaTIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Manuel Monter and LPM Manzano conducted an unannounced annual inspection visit today, and met with Executive Director (ED) Ranulfo Garcia.

LPA toured the facility. Observed classrooms where the residents participate in arts and craft. There is a designated area for clients who require a one-on-one space, also known as the lounge room. Observed cubicles where the residents can store their belongings. There are four restrooms and one shower. Observed locked storage room where the toxic materials are kept. Tested the hot water temperature at in the restroom across from the lounge room. 112 degrees F. Last disaster drill was conducted on June 10, 2023. Fire extinguishers were charged and last serviced in February 2023. Observed the Carbon monoxide detectors inside the front area. The facility has nine (9) transportation vans and are all in good operating conditions, however 1 is under repair. A chicken coop is located on the outside of the facility alongside the garden area which is for stimulation and training. The facility has cctv to monitor the outside of the Adult day program. ED stated he will submit plan in regards to cameras by 07/11/2023. ED stated the facility has 64 clients total and 34 staff total. ED stated there are 6 staff who are one-on-one. They have a ratio of 1:3.

LPA reviewed a random selection (5%)of residents and staff files. Residents have current Needs and Services Care plans and physicians assessments/TB clearances. Staff stated that there is one residents who take medications for seizure, and staff are trained on medication. Staff have current training, required training, including first aid and CPR on file, physicians assessments/TB clearances, and are fingerprint cleared and associated. There were adequate direct care staff for all of the clients.

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: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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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