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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202688
Report Date: 10/12/2021
Date Signed: 10/13/2021 02:19:10 PM

Document Has Been Signed on 10/13/2021 02:19 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: 33DATE:
10/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Mark NielsenTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an unannounced infection control site visit. LPA met with the Program Director (PD) Mark Nielsen.

One central entry point was designated for all clients. Staff temperature check and screen the clients before they are allowed to exit the vehicles and enter the facility in the morning in the parking lot. An extra 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. The facility was observed to be in sanitary condition, in comfortable temperature, and well ventilated. All staff in the facility wore masks at all time. Clients were having different activities in different areas. 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.

A plan for epidemic outbreak specific to COVID-19 mitigation plan report (LIC 808) from the facility was submitted and approved by the Department. 12 out of 16 staff and all clients in the facility were fully vaccinated per PD.

An advisory note was issued. No deficiency cited during visit.

This report was reviewed with PD. A copy of this report and advisory note were provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Yatfai Ng
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
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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