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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011440620
Report Date: 07/14/2023
Date Signed: 07/14/2023 01:41:07 PM

Document Has Been Signed on 07/14/2023 01:41 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, STE. 310
OAKLAND, CA 94612
FACILITY NAME:KEYSTONE ADULT LEARNING CENTERFACILITY NUMBER:
011440620
ADMINISTRATOR:BRUM, NANCYFACILITY TYPE:
775
ADDRESS:1241 QUARRY LANE, SUITE 145TELEPHONE:
(925) 484-5330
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 30CENSUS: 18DATE:
07/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nancy Brum, Executive DirectorTIME COMPLETED:
01:50 PM
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On 7/14/2023 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Executive Director, Nancy Brum. The facility’s fire clearance was approved for 30 clients of which 10 may be non-ambulatory.

LPA toured the facility including but not limited to activity rooms, resting room, common areas, bathrooms, and kitchen. Facility does not have an outdoor activity space. Smoke and carbon monoxide detectors were observed. Fire extinguishers were observed to be full and last serviced on 2/2/2023. Clients bring lunch from home and facility can provide lunches for clients if needed. Facility has sufficient snacks and food supplies for clients. Hot water temperature in the classroom bathroom was measured at 111.7 degrees F. All observed toilets and hand washing stations are maintained in a safe, sanitary, and operating condition. There are no bodies of water observed. First aid kit was complete. The last disaster drill was conducted on 5/9/2023.

LPA reviewed 4 clients and 3 staff files starting at 10:50AM. LPA interviewed 3 clients and 3 staff starting at 10:30AM.

No deficiency is being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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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