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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202437
Report Date: 07/08/2021
Date Signed: 08/18/2021 03:15:54 PM

Document Has Been Signed on 08/18/2021 03:15 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
,
, CA
FACILITY NAME:GREATER OPPORTUNITIESFACILITY NUMBER:
435202437
ADMINISTRATOR:ANTHONY ROWEFACILITY TYPE:
775
ADDRESS:687 NORTH KING ROADTELEPHONE:
(408) 272-3629
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY: 75CENSUS: 0DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mina KarimTIME COMPLETED:
02:30 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) David Marrufo conducted an unannounced COVID-19 Infection Control Visit and met with Mina Karim.

During visit, LPA Marrufo toured the facility. The facility had a visitor screening area with hand sanitizer, temperature screening, and log. LPA Marrufo toured the facility bathrooms and observed them to have available soap and paper towels as well as posters with hand washing instructions. LPA Marrufo observed the facility activity rooms and isolation room. LPA Marrufo observed the facility PPE supply and found there to be a 30-day supply of PPEs. LPA toured the facility kitchen area and changing room.

No deficiencies were cited at this time per California Code of Regulations Title 22.

LPA Marrufo requests that the following documents be updated and sent to CCL within 7 days:

1. LIC308 Designation of Administrative Responsibility
2. LIC610 Emergency Disaster Plan

This report was reviewed with Mina Karim and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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