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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200135
Report Date: 07/14/2023
Date Signed: 07/17/2023 05:06:17 PM

Document Has Been Signed on 07/17/2023 05:06 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:ARC OF THE EAST BAY WALPERT AVP PROGRAM, THEFACILITY NUMBER:
019200135
ADMINISTRATOR:TUTTLE, RENEEFACILITY TYPE:
775
ADDRESS:1101 WALPERT STREETTELEPHONE:
(510) 357-3569
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 200CENSUS: 53DATE:
07/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Renee Tuttle/Program DirectorTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual required inspection. LPA met with Program Director Renee Tuttle, and informed the purpose of visit.

Director of Operation Joanne Rolle submitted the facility's Infection Control Plan which LPA received on June 23, 2022.

LPA toured the facility inside out with Renee Tuttle. LPA inspected building #s 1, 2, 3, 4 (Larc Hall) and 5 (front office building), common areas and kitchen in building # 4. All buildings except Larc Hall and front office have quiet rooms. Facility has adequate supplies of snacks and activity materials. First aid kits inspected and observed complete with manual. Storages for cleaning supplies were observed locked.

All buildings have fire extinguishers which LPA observed fully charge with tags showed serviced 9/23/22 and 10/22/22. Hot water temperature in one of the bathrooms in building # 3 was tested, and measured at 106.2 degrees Fahrenheit. Facility conducts disaster drills at least once every six months, and records showed last conducted June 7, 2023. Facility has smoke detectors and carbon monoxide that are in operating condition.

LPA reviewed 5 staff and 5 residents files, and interviewed 3 staff and 3 clients.

No deficiency during today's inspection.

Exit interview conducted, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
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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