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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202432
Report Date: 03/26/2024
Date Signed: 03/26/2024 09:47:18 PM

Document Has Been Signed on 03/26/2024 09:47 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:TRAINING CENTER, THEFACILITY NUMBER:
435202432
ADMINISTRATOR:MONA HADAFACILITY TYPE:
775
ADDRESS:7996 WESTWOOD DRIVETELEPHONE:
(408) 713-2771
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 30CENSUS: 17DATE:
03/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Mona Hada Program DirectorTIME COMPLETED:
02:40 PM
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At 12:05 pm Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived at the facility, and met with Program Director (PD) Mona Hada. LPA stated the purpose of the visit is to conduct an unannounced 1 year required visit.

LPA observed 12 staff attending to clients during lunch.

LPA toured the facility with PD to include but not limited to the main activity area, two changing rooms, medication room, two restrooms, and kitchen. The facility temperature ranged from 68 to 71 degrees Fahrenheit. The hot water was measured in the kitchen and bathroom temperature ranges from 110 to 117 degrees F. Medications were locked and inaccessible to clients in care.

Maintenance and Safety logs were viewed for 2 buses and 2 vans used to transport clients. Bus #1 was last serviced on 10/10/2023. Bus #2 was last serviced on 09/15/2023. The Blue Van was last serviced on 02/12/2024. Van #3 is Navy Blue was last serviced on 3/15/2024.

Facility fire extinguisher was last serviced on 12/18/2023, smoke and carbon monoxide detectors are in good working condition. First aid kits were inspected and observed to be complete.

Four client files were reviewed including Admission Agreements, Physician's Report, and Needs and Services Plan, including centrally stored medication and destruction record (CSMDR). 4 staff files were reviewed, for First Aid/CPR training, Health Screening, and Fingerprint Clearance. Four client P&I monies were reviewed were accounted for. In-service training for staff were reviewed including topic, time, and sign in for staff.

page 1 continued to page 2 LIC 809C
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: TRAINING CENTER, THE
FACILITY NUMBER: 435202432
VISIT DATE: 03/26/2024
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LPA Partoza received updated copies of Personnel Report (LIC 500) and Designation of Facility Responsibility (LIC 308), Emergency Disaster Plan (LIC 610D), Facility Sketch list of clients list, copy of Surety Bond.

No deficiencies were cited during today’s visit. An exit interview was conducted with Administrator, Mona Hada.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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