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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202823
Report Date: 10/27/2021
Date Signed: 10/27/2021 04:53:28 PM

Document Has Been Signed on 10/27/2021 04:53 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:APOLLO ADULT DAY PROGRAMFACILITY NUMBER:
435202823
ADMINISTRATOR:LAUREL, PATRICK M.FACILITY TYPE:
775
ADDRESS:888 CAPITOL AVETELEPHONE:
(408) 439-2636
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 150CENSUS: 0DATE:
10/27/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Patrick LaurelTIME COMPLETED:
01:10 PM
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Licensing Program Manager (LPM) Romeo Manzano and Licensing Program Analyst (LPA) conducted a Pre Licensing visit today, and met with President/Administrator (ADM) Patrick Laurel. This is a relocation from Apollo Adult Day Program #435202395.

The licensee has increased capacity from 120 to 150 (25 Out of 150 is Non-Ambulatory).
The entire the facility is equipped with sprinklers system. The facility has an approve fire extinguishers for a year and 19 CCTV installed in and out of the facility (except conference areas and restrooms). There are 5 designated fire exits in the facility. Licensee will update LIC610 D to CAB.

The facility has two restrooms for clients and staff (for both gender). The facility water temperature was measured at 105 degree F and the room temperature was at 69 degree F. The facility kitchen was equipped with appliances such as refrigerator, microwave and stove burner. LPA recommended to remove the stove knob when not in use for safety.

The facility common areas were inspected based on the submitted floor plan such as reception lobby, conference room, library, activity rooms (with no dividers), break room, kitchen, restrooms, offices, break room and movie room.

LPA also toured the facility backyard. Licensee was in the process of dumping and cleaning up the yard. Licensee will ensure that the yard will be cleaned up before its opening. LPA also suggested to work with the property landlord regarding backyard fence between the facility and the church.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: APOLLO ADULT DAY PROGRAM
FACILITY NUMBER: 435202823
VISIT DATE: 10/27/2021
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LPA advised licensee to collaborate with CAB analyst on the licensure of this location. The current facility (#435202395) has to be closed on the same day this facility is licensed. Licensee also stated that San Andreas Regional Center (SARC) has been informed and is working on transferring of their vendorization.

Component III orientation was completed with licensee. No issues noted during the pre-licensing tele-inspection. The physical plant is approved pending the completion of Centralized Application Bureau (CAB) review of the facility application. Exit interview conducted with and copy of report provided to Patrick Laurel.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
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