<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202202
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:12:10 PM

Document Has Been Signed on 06/23/2022 12:12 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:CREATIVE MIND DAY PROGRAMFACILITY NUMBER:
435202202
ADMINISTRATOR:NAOMI APOSTOL-MILESFACILITY TYPE:
775
ADDRESS:7425 EIGLEBERRY STREETTELEPHONE:
(408) 427-9260
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 50CENSUS: DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Naomi Apostol-MilesTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Administrator/Program Director Naomi Apostol-Miles.

The day program is open for in-person and virtually Monday - Thursday from 9:00 a.m - 2:30 p.m. Clients were out in the community during visit.

During visit, LPA toured the facility inside and out to include the entry, classrooms, office, isolation room, kitchen, bathroom, and exterior. All fire exit routes were free and clear of obstructions. Facility observed to have designated entry point for COVID 19 symptom screening. Clients are being screened prior to entering in the transportation vehicle. Facility are co-horting groups to attend in-person program. LPA reviewed the facility's visitation policy. Facility has a designated isolation room. Bathrooms observed to be supplied with hygiene products, paper supplies, and a hand washing sign. Hand sanitizer available. LPA observed supply of Personal Protective Equipment (PPE). Needed medications will be stored in locked cabinet in the kitchen. The following posters were observed to include symptoms of COVID, airborne precaution, cover your cough, social distancing, and wear a face mask.

Administrator will send LPA an updated LIC500, LIC610D, and LIC308.

No citations were issued per the California Code of Regulations, Title 22.

This report was reviewed with Naomi Apostol-Miles Administrator/Program Director and a copy of the report provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1