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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206027
Report Date: 08/23/2023
Date Signed: 08/23/2023 02:16:07 PM


Document Has Been Signed on 08/23/2023 02:16 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:ST. VINCENT'S DAY HOMEFACILITY NUMBER:
010206027
ADMINISTRATOR:YOUNGBLOOD, JENNIFERFACILITY TYPE:
850
ADDRESS:1086 8TH STREETTELEPHONE:
(510) 832-8324
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY:261CENSUS: 111DATE:
08/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Alicia WinbushTIME COMPLETED:
02:15 PM
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LPA Diana Campos met with Associate Director Alicia Winbush for a case management inspection as a result of receiving an unusual incident report. An incident occurred when a child received scratches while in care. Interviews were conducted and physical plant was toured. A copy of the children's roster was obtained. Staff were unaware of how the child sustained the scratches. During the investigation LPA toured the facility, interviewed staff, and obtained copies of relevant documents.

No deficiencies were cited as a result of today's visit.

Exit interview was conducted and the report reviewed with Executive Director Alexandra Hilario.
A site visit notice was issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
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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