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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202261
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:55:53 PM

Document Has Been Signed on 05/04/2022 03:55 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:MISSION BAY LAS COLINASFACILITY NUMBER:
435202261
ADMINISTRATOR:MARIA COKERFACILITY TYPE:
775
ADDRESS:50 LAS COLINAS LANETELEPHONE:
(408) 661-4883
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 177CENSUS: 120DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Dennis MiclatTIME COMPLETED:
01:53 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit today, and met with Program Director (PD) Dennis Miclat.

Upon arrival, the front desk staff took LPA temperature, and logged LPA in the visitor log book. LPA observed the COVID posters on the main door. LPA toured the whole facility with PD.

LPA observed the COVID posters in facility. LPA observed all the staff were wearing masks. 1 file room, offices, 1 conference room, 8 classrooms, 4 activity areas, 1 theater, 7 restrooms, 2 kitchens, 1 library, 1 music room, two client break rooms, and 1 staff break room were observed and inspected.

Some restrooms without washing hands for 20 seconds posters. Some restrooms have trash cans with covers and trash cans without covers. Some trash cans without covers were observed in facility common area. LPA observed many clients participated in the day program activities.

LPA suggested PD to put more hand sanitizers at the activity areas, classrooms, and kitchens.

Before exit interview with PD. PD showed LPA that the facility already put the washing hands for 20 seconds posters in all restrooms, and removed those trash cans without covers.

Exit interview was conducted with PD, No citation was noted for today visit. This report was provided to PD for signature.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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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