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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601501
Report Date: 07/14/2020
Date Signed: 07/14/2020 04:50:24 PM

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:LANDMARK VILLAFACILITY NUMBER:
015601501
ADMINISTRATOR:PEDERSON, DIANEFACILITY TYPE:
740
ADDRESS:21000 MISSION BLVD.TELEPHONE:
(510) 276-2872
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:140CENSUS: 90DATE:
07/14/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Executive Director Diane Pederson. TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Delmundo called and spoke with Executive Director Diane Pederson. LPA explained that the reason for the call is to inform that a complaint has been received and that LPA will conduct health and safety inspection with using FaceTime.

LPA requested Ms. Pederson to tour LPA on three of randomly selected residents' apartments, two on the third floor and one on the second floor. LPA observed the hallways free of hazards. The apartments were observed equipped with pull cords, one in the living room area, one in the bedroom and one in the bathroom. LPA also observed the apartments clean. LPA requested Ms. Pederson to tour LPA to the two patios. LPA observed the patios without obstructions.

No deficiency observed on this day.

Exit interview conducted and copy of this report provided to Ms. Pederson via e-mail.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2020
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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