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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202593
Report Date: 11/12/2021
Date Signed: 11/12/2021 12:12:52 PM

Document Has Been Signed on 11/12/2021 12:12 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:INTEGRATED LEARNING CENTERFACILITY NUMBER:
435202593
ADMINISTRATOR:YAU, LIHUEIFACILITY TYPE:
775
ADDRESS:511 S BASCOMTELEPHONE:
(650) 799-4099
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 20CENSUS: 0DATE:
11/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:YAU, LIHUEITIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Christine Dolores conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Lihuei Yau Administrator. LPA observed no clients on site. The facility's program is currently on hold for in-person and virtual program, due to COVID-19 and plans to resume operations in 2022.

LPA toured the facility inside and out to include the central entry point, activity rooms, isolation room, bathroom, and exterior.

All fire exit routes were free and clear of obstructions. Bathroom observed to be supplied with hygiene products and paper supplies. Hand washing signs were posted in bathroom. Hand sanitizer available to all clients, visitors, and staff. Facility plans to disinfect surfaces frequently and as needed. LPA observed the following posters to include steps to minimize risk of COVID-19, to prevent the spread of COVID-19, and cough etiquette. LPA observed supply of Personal Protective Equipment.

LPA reviewed the facility policies and procedures to include screening, isolation, disinfecting, staffing, training, supplies, PPE usage and social distancing.

LPA will provide Administrator additional PPE supplies to include gowns and COVID-19 resources.

No deficiencies cited during today's visit. Advisory notes provided to the Administrator.

LPA reviewed report with Lihuei Yau Administrator and a copy of the report provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2021
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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