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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202202
Report Date: 06/20/2024
Date Signed: 06/20/2024 11:23:37 AM

Document Has Been Signed on 06/20/2024 11:23 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
Lookup Error,
, CA
FACILITY NAME:CREATIVE MIND DAY PROGRAMFACILITY NUMBER:
435202202
ADMINISTRATOR/
DIRECTOR:
NAOMI APOSTOL-MILESFACILITY TYPE:
775
ADDRESS:7425 EIGLEBERRY STREETTELEPHONE:
(408) 427-9260
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 50CENSUS: 15DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Naomi Apostol-MilesTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 6/20/2024, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator/Program Director Naomi Apostol-Miles & Assistant Program Director Rhodora Deloso. LPA explained the purpose of the visit.

LPA toured the facility including all of activity rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. LPA observed that the purple room had a leak and repair has been scheduled. LPA observed clients doing activities in two rooms. While touring the facility it was observed that the room temperature was at 70 deg F. Hot water was also tested in the bathrooms and the temperature was 110 deg F. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current. Client bathrooms were observed to be in good repair. Food are brought in by residents prepared from their home facilities. Snacks are provided in case clients are not able to bring food.. Chemicals are in locked cabinets. Medication is not administered in the facility. Emergency drills are done quarterly.

Five client records and five staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Facility has a certified administrator on site.

LPA received the following from facility: LIC500, Current Administrator Certificate.

No deficiencies are cited at this time. Report is reviewed and a copy is provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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