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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202647
Report Date: 12/23/2020
Date Signed: 12/23/2020 03:11:06 PM

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:PARKSIDE VILLA INCFACILITY NUMBER:
435202647
ADMINISTRATOR:FORONDA-CAYABYAB, MARIEFACILITY TYPE:
740
ADDRESS:300 S 22ND STTELEPHONE:
(408) 831-7411
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:15CENSUS: 15DATE:
12/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Christopher Cayabyab, AdministratorTIME COMPLETED:
11:30 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) Jackie Jin and California Department of Public Health HFEN Nurse conducted a tele-visit via FaceTime to provide technical assistance to prevent and mitigate the spread of COVID-19. LPA met with Christopher Cayabyab, Administrator.

During today's tele-visit, the following recommendations were made to the facility:
  2. Increase screening of clients and staff.
  4. Purchase additional trash cans with covering.
  6. If possible, have isolation room door close.
  8. Post how to put on and take off PPE poster on every isolation room door.
  10. Increase disinfection at the facility.
  12. Increase hand washing to one minute.
  14. Purchase Z fold paper towels or paper towel holder.
This report was reviewed with Christopher Cayabyab, Administrator and a copy of this report will be emailed to Christopher Cayabyab, Administrator on 12/23/2020 for signature.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
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