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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200188
Report Date: 04/12/2024
Date Signed: 04/12/2024 03:43:04 PM

Document Has Been Signed on 04/12/2024 03:43 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:DEBBIE'S HOME AWAY FROM HOME IIIFACILITY NUMBER:
019200188
ADMINISTRATOR/
DIRECTOR:		DEBRA PICKENSFACILITY TYPE:
735
ADDRESS:8949 SENECA STREETTELEPHONE:
(510) 549-6001
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 6CENSUS: DATE:
04/12/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Debra Pickens, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 4/12/24 at 3:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived to continue 1-Year Annual Required inspection. LPA met with Administrator, Debra Pickens and explained the purpose of the visit.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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