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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600229
Report Date: 08/23/2024
Date Signed: 08/23/2024 03:48:50 PM

Document Has Been Signed on 08/23/2024 03:48 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:JASMINE'S CARE HOMEFACILITY NUMBER:
015600229
ADMINISTRATOR/
DIRECTOR:		MITCHELL, TRACYFACILITY TYPE:
735
ADDRESS:1042A CALCOT PLACETELEPHONE:
(510) 532-4556
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 8CENSUS: 1DATE:
08/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Tracy Mitchell, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 8/23/24 at 3:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct Case Management visit. LPA met with Tracy Mitchell, Licensee and explained the purpose of the visit.

During the visit LPA delivered an Amended report for the visit conducted on 6/06/24, a citation for the facility not having an administrator and a citation for Dell's Residential Facility (#075600400).

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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