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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202432
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:45:37 PM

Document Has Been Signed on 05/25/2022 02:45 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:TRAINING CENTER, THEFACILITY NUMBER:
435202432
ADMINISTRATOR:MONA HADAFACILITY TYPE:
775
ADDRESS:7996 WESTWOOD DRIVETELEPHONE:
(408) 713-2771
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 30CENSUS: 14DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Mona HadaTIME COMPLETED:
11:10 AM
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 an annual inspection focusing on infection control. LPA met with Administrator, Mona Hada. The day program resumed operations in October 2021 and offers in-person program on Monday, Tuesday, Wednesday, and Friday.

During visit, LPA toured the facility to include the activity room, changing rooms, bathrooms, break room, designated visitation area, and isolation area. All exit routes were free and clear of obstruction. Medications were observed secured. All staff observed to be wearing a face mask.

Facility observed to have central entry point for symptoms screening and sign-in for all clients, staff, and visitors. Temperature is taken upon entry. Hand sanitizer was made available upon entry and throughout the facility. Facility cohorts groups by houses during the day program and in the transportation vehicle. Tables were observed socially distanced. Bathrooms observed to be supplied with hygiene products, paper supplies, and hand washing sign. Facility clean and disinfects daily and as needed. LPA reviewed the facility's policies and procedures to isolation. LPA advised staff to wear proper PPE if caring/supervising a client who is symptomatic and providing transportation to the home. LPA observed the following posters to include always wear a mask, social distancing, hand washing procedures, and symptoms of COVID.

LPA observed the transportation vehicle to be supplied with hand sanitizer and disinfectant wipes. The driver has a scheduled pick-up time for each home and cleans / disinfects the vehicle before and after picking up each group.

LPA informed Administrator to review PIN 22-13-ASC and to submit Infection Control Plan to CCLD by 06/30/2022. No citations were issued per the California Code of Regulations, Title 22. This report was reviewed with Mona Hada and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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