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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202154
Report Date: 03/19/2024
Date Signed: 03/19/2024 10:18:50 AM

Document Has Been Signed on 03/19/2024 10:18 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MISSION BAY, INC.FACILITY NUMBER:
435202154
ADMINISTRATOR:MARIA COKERFACILITY TYPE:
775
ADDRESS:980 RINCON CIR.TELEPHONE:
(408) 433-3303
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY: 135CENSUS: 117DATE:
03/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Program Director Raul Regencia and Marion Cookie Cozine Assistant Program Director TIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Program Director (PD) Raul Regencia and Marion Cookie Cozine Assistant Program Director (APD) During LPA's visit, PD stated there are currently 115 clients and 53 staff.

LPA toured the facility inside out with APD which included the lobby, computer rooms, activity area, activity rooms and restrooms. The staff area of the facility was also inspected. The outside of the day program was also inspected. There was no obstruction to block the walkways.

The facility does not provide meals except snacks. LPA observed the medication storage area, and cleaning product storage area as locked and inaccessible to clients in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 118 degrees F in both client restrooms.

Fire extinguisher was serviced in October 16, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested on October 16, 2023, by Nickell Fire Protection. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on March 6, 2024.

LPA reviewed facility records for 4 staff and 4 clients. LPA reviewed 3 client medications and centrally stored medication records. LPA conducted interviews with 2 staff and 0 clients. Clients left day program for an outing and LPA was unable to interview them.

No deficiencies cited during today's visit. This report was reviewed with Program Director (PD) Raul Regencia and a copy of the signed report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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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