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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202437
Report Date: 07/30/2024
Date Signed: 07/30/2024 02:00:08 PM

Document Has Been Signed on 07/30/2024 02:00 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:GREATER OPPORTUNITIESFACILITY NUMBER:
435202437
ADMINISTRATOR/
DIRECTOR:		ANTHONY ROWEFACILITY TYPE:
775
ADDRESS:687 NORTH KING ROADTELEPHONE:
(408) 272-3629
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY: 75CENSUS: 50DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Akhom Kham, Evan Fernandez and Mina KarimTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 7/30/2024, at 8:45 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year annual inspection. LPA was greeted by staff (S1) and S1 called assistant program administrator (APA) Akhom Kham. LPA stated the purpose of the visit.

The facility is an adult day program licensed to serve the community 18 and over.

At 9:10 a.m. LPA with APA, toured the facility. LPA observed some of the participants were participating in the exercise video in the activity area, while others are in the art room. Observed classrooms for art and computer workshop. There are lockers for the participants and a refrigerator for the participants to store their belongings and lunches. There are five bathrooms and one room for privacy. The facility has four vans and one truck for transportation which is maintained and documented. Observed a carbon monoxide detector inside the kitchen. The fire smoke alarms were in good operational condition. Last disaster drill was conducted on 7/8/2024. Hot water temperature measured 115 degree F. Overall, the facility meets the staffing ratio and needs of clients.

At 9:50 am, LPA interviewed 3 staff and reviewed a random selection of staff and participants files. No participant is taking medication at the facility.

At 10:40 a.m. Senior Program Manager (SPM) Mina Karim arrived at the facility. LPA discussed the following with SPM, housekeeping, staff files, criminal background clearance transfer for one staff (S3) who started working at the facility on 5/1/2024. LPA provided advisory notes to SPM for record keeping.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: GREATER OPPORTUNITIES
FACILITY NUMBER: 435202437
VISIT DATE: 07/30/2024
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Facility will submit the following forms within 15 days to CCL:

LIC 308 Designation of Administrative Responsibility
LIC 500 Personnel Report
LIC 610 Emergency Disaster Plan
Certificate of Liability Insurance
Lease agreement

Deficiency is being cited during today's visit per California Code of Regulation, Title 22 article 82019 (e)(2).

A civil penalty is being assessed per Section 82054(a), an immediate penalty of $100 per cited violation per day for a maximum of five (5) days (a total of $500) shall be assessed if any individual required to be fingerprinted under Health and Safety Code Section 1522(b) has not obtained a California clearance or a criminal record exemption, requested a transfer of a criminal record clearance or requested and be approved for a transfer of an exemption as specified in Section 82019(e) prior to working, residing or volunteering in the facility.

An exit interview was conducted with Senior Program Manager Mina Karim. A copy of the report and appeals rights were provided.

end of report
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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/30/2024 02:00 PM - It Cannot Be Edited


Created By: Maria Partoza On 07/30/2024 at 01:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: GREATER OPPORTUNITIES
FACILITY NUMBER: 435202437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)(2)
82019 Criminal Record Clearance (e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (2) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f)...
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee/SPM did not request a transfer of a criminal record clearance of a staff (S3) prior to employment of 5/1/2024, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2024
Plan of Correction
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SPM was not aware that S3s criminal record clearance was not transferred prior to starting S3s employment at the facility. SPM emailed Guardian to work on S3s criminal record clearance transfer and to associate S3 to the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Maria Partoza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024


LIC809 (FAS) - (06/04)
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