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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011441112
Report Date: 08/25/2021
Date Signed: 08/25/2021 01:36:54 PM

Document Has Been Signed on 08/25/2021 01:36 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:ABILITY NOW BAY AREA, INC.FACILITY NUMBER:
011441112
ADMINISTRATOR:DECOSTE, MAUREENFACILITY TYPE:
775
ADDRESS:4500 LINCOLN AVENUETELEPHONE:
(510) 531-3323
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY: 100CENSUS: 19DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maureen Decoste, AdministratorTIME COMPLETED:
01:50 PM
NARRATIVE
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On 8/25/2021 at 10am, Licensing Program Analysts (LPAs) Catherine Lin and Grace Luk arrived unannounced to conduct an annual required/infection control inspection. LPAs met with the administrator, Maureen Decoste and Quality Assurance Director, Mara Bearse and informed the purpose of the visit.

LPAs toured the facility with both Maureen and Mara. LPAs inspected the lobby, storeroom, classrooms, activity rooms, common areas, kitchen, backyard, dining area, and bathrooms. Bathrooms were observed with step-on trash bins with lids, liquid soap, paper tower, and hand-washing signs.

COVID-19 postings were observed in common areas and hallways. Facility has hand sanitizer, masks, and gloves available by the entrance door. Staff screens visitors prior to allowing entry. Facility has visitor's log. Facility has a copy of LIC808 Mitigation Plan, Emergency Disaster Plan, and Clients Roster on file.

The following deficiency was observed during the visit:

  • At 10:40am, LPAs observed unlocked gardening fertilizers in a cabinet located in the backyard. Staff locked up the fertilizers during the inspection.

Deficiencies were cited from Title 22 California Code of Regulations (see LIC809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties.

Exit interview conducted. Appeal Rights and copy of this report provided
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 08/25/2021 01:36 PM - It Cannot Be Edited


Created By: Catherine Lin On 08/25/2021 at 01:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ABILITY NOW BAY AREA, INC.
FACILITY NUMBER: 011441112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (observation, the licensee did not comply with the section cited above by having unlocked gardening fertilizers which poses an immediate health and safety risk to persons in care.
POC Due Date: 08/26/2021
Plan of Correction
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Staff locked up fertilizers during inspection.

Deficiency cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Catherine Lin
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
Page: 2 of 4