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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
010206027
Report Date:
10/23/2024
Date Signed:
10/23/2024 05:01:34 PM
Document Has Been Signed on
10/23/2024 05:01 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
OAKLAND CC RO
,
1515 CLAY STREET, SUITE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
ST. VINCENT'S DAY HOME
FACILITY NUMBER:
010206027
ADMINISTRATOR:
YOUNGBLOOD, JENNIFER
FACILITY TYPE:
850
ADDRESS:
1086 8TH STREET
TELEPHONE:
(510) 832-8324
CITY:
OAKLAND
STATE:
CA
ZIP CODE:
94607
CAPACITY:
261
CENSUS:
120
DATE:
10/23/2024
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:15 PM
MET WITH:
David Rodriguez and Alexandra Hillario
TIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta and Kayla Merchant conducted an unannounced visit to following up on self reported incidents. LPAs met with Executive Director Alexandra Hillario and Program Director David Rodriguez.
During the visit LPAs conducted interviews.
There are no deficiencies cited today.
Exit interview and report reviewed with David Rodriguez and Alexandra Hillario.
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME:
Sherelle Johnson
TELEPHONE:
(510) 622-2592
LICENSING EVALUATOR NAME:
Cherie Acosta
TELEPHONE:
(510) 856-6376
LICENSING EVALUATOR SIGNATURE:
DATE:
10/23/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/23/2024
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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