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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601280
Report Date: 12/03/2024
Date Signed: 12/03/2024 01:28:40 PM

Document Has Been Signed on 12/03/2024 01:28 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 ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:FREMONT VILLAGEFACILITY NUMBER:
015601280
ADMINISTRATOR/
DIRECTOR:		GINA A VELAYOFACILITY TYPE:
740
ADDRESS:38801 HASTINGS STREETTELEPHONE:
(510) 792-5411
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 120TOTAL ENROLLED CHILDREN: 0CENSUS: 60DATE:
12/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Gina Velayo, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 12/03/2024 at 12:15 PM, Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen conducted an unannounced POC visit regarding the deficiency issued on 10/29/2024. LPAs met with Administrator, Gina Velayo and explained the purpose of the visit.

During the annual visit on 10/29/2024, the freezer thermostat was not functioning properly. On 11/02/2024, Administrator sent proof of purchase of thermostat via email to LPA. On 11/08/2024, Administrator sent proof of the thermostat installed via email to LPA. LPA wanted to confirm if the thermostat is functioning properly while at the facility for another visit on this date.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Yvonne Flores-LariosTELEPHONE: (510) 286-4201
Patricia ManaloTELEPHONE: (916) 432-7785
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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