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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202261
Report Date: 04/12/2024
Date Signed: 04/12/2024 11:50:08 AM

Document Has Been Signed on 04/12/2024 11:50 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 LAS COLINASFACILITY NUMBER:
435202261
ADMINISTRATOR/
DIRECTOR:
MARIA COKERFACILITY TYPE:
775
ADDRESS:50 LAS COLINAS LANETELEPHONE:
(408) 661-4883
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 177CENSUS: 164DATE:
04/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Program Director Dennis MiclatTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Program Director (PD) Dennis Miclat. During the visit, PD stated the facility currently has 164 residents and 71 staff.

LPA toured the facility inside out with PD which included the the activity rooms, offices, bathrooms & kitchen areas. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways.

Two-day perishable food supplies and seven day nonperishable food supplies were observed. 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 71 degrees F, and hot water temperature was measured to range from 107-109 degrees in facility bathrooms.

Fire extinguisher was serviced in April 20, 2023. The facility was equipped with smoke and carbon monoxide detectors. PD stated the sprinkler system was last inspected on February 26, 2024. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on February 13, 2024. .

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

No deficiencies cited during today's visit. This report was reviewed with Program Director Dennis Miclat and a copy of the signed report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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