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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200158
Report Date: 01/17/2025
Date Signed: 01/17/2025 01:32:52 PM

Document Has Been Signed on 01/17/2025 01:32 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:MISSION HOPE DAY PROGRAM- HAYWARDFACILITY NUMBER:
019200158
ADMINISTRATOR/
DIRECTOR:		JAY FRANCIS Y GAMEZFACILITY TYPE:
775
ADDRESS:21328 MISSION BLVD.TELEPHONE:
(510) 888-9231
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 45CENSUS: 45DATE:
01/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Augustine Udoh, ManagerTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 01/17/2025 at 12:05 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Administrator Augustine Udoh and explained the purpose of the visit. Administrator Gloria Gonzalez was called and informed of the visit.

LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the activity spaces, offices, lounge room, kitchens, bathrooms, and quiet room. There is a comfortable room temperature of 70 degrees Fahrenheit for clients in care. Centrally stored medications, toxins and sharp objects were locked and inaccessible to participants. Activity supplies were available. Outdoor activity space was observed with chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 11/23/2024.

At 12:20 pm LPA reviewed 4 residents records. At 12:45 pm, LPA reviewed 3 staff records and 3 of 3 were fingerprint cleared and associated to the facility.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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