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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202031
Report Date: 06/17/2024
Date Signed: 06/17/2024 01:33:06 PM

Document Has Been Signed on 06/17/2024 01:33 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/
DIRECTOR:
RANULFO DIEGO GARCIAFACILITY TYPE:
775
ADDRESS:1325-1333 PIEDMONT RD #109-110TELEPHONE:
(408) 347-0402
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY: 75CENSUS: 71DATE:
06/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:03 PM
MET WITH:Administrator Ranulfo Diego GarciaTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Ranulfo Diego Garcia. During the visit, ADM stated the facility has 71 residents attending day program and 36 staff. ED stated there are 7 staff who are 1-on-1. They have a ratio of 1:3.

LPA toured the facility inside out with ADM 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.. The front yard and backyard were inspected. A chicken coop is located on the outside of the facility alongside the garden area which is for stimulation and training. There was no obstruction to block the walkways.

ADM stated all residents bring their own food for lunch as well as snacks. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 72 degrees F, and hot water temperature was measured at 108 degrees F in resident bathrooms.

Fire extinguisher was serviced in February 9, 2024. The facility was equipped with smoke and carbon monoxide detectors. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on April 8, 2024.

LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 2 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff and 2 residents.

No deficiencies cited during today's visit. This report was reviewed with Administrator Ranulfo Diego Garcia and a copy of the signed report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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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