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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202688
Report Date: 10/08/2021
Date Signed: 10/13/2021 02:18:06 PM

Document Has Been Signed on 10/13/2021 02:18 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:MORGAN AUTISM CENTERFACILITY NUMBER:
435202688
ADMINISTRATOR:BRAD BOARDMANFACILITY TYPE:
775
ADDRESS:950 ST. ELIZABETH DRIVETELEPHONE:
(408) 241-8161
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY: 50CENSUS: 32DATE:
10/08/2021
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mark NielsenTIME COMPLETED:
03:14 PM
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Due to a positive COVID-19 case in the facility, Licensing Program Manager (LPM) Sarah Yip and Licensing Program Analyst (LPA) Yatfai Eric Ng conducted a Case Management - COVID-19 - tele-visit via FaceTime, to provide a technical assistance to prevent and to mitigate the spread of COVID-19 at the facility. LPM and LPA met with the Program Director (PD) Mark Nielsen.

The tour started at the parking lot where staff would temperature check and screen the clients before they are allowed to exit the vehicles and enter the facility in the morning. A screening station with thermometers, hand sanitizer, masks, gloves, sign-in sheet, and COVID-19 questionnaire was also present at the entrance. There were COVID-19 signages at the entrance and throughout the facility. Hand sanitizers were readily available in different areas. All staff in the facility wore masks at all time. 2 Restrooms were toured. Soap, paper towels, and personal protective equipment (PPE) such as gloves, masks, and wipes were present. Hand washing signs were posted. The facility purchased more tables in order to seat the clients at least 6 feet apart. Sneezeguards were procured to divide the clients. The facility cleaned and sanitized the high traffic areas twice a day. PD audited and ordered PPE supply regularly to make sure there was a sufficient supply. Screening procedure and isolation practice were reviewed.

The following infection control practices were suggested:
  1. Review the Provider Information Notices PIN 21-40-ASC about the latest visitation guidance from the Department.
  2. Replace all trash bins without lids with foot-operated trash bins with lids

No deficiency cited during visit. PD stated the recommendations would be reviewed and implemented.

This report was emailed to PD to review and to obtain a signature.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Yatfai Ng
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2021
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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