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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200199
Report Date: 04/06/2022
Date Signed: 04/29/2022 02:34:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2021 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20210707162143
FACILITY NAME:FCSN EAST BAY ADULT DAY PROGRAMFACILITY NUMBER:
019200199
ADMINISTRATOR:AI-CHING "SYLVIA" YEHFACILITY TYPE:
775
ADDRESS:2300 PERALTA BLVD.TELEPHONE:
(510) 739-6900
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:105CENSUS: 45DATE:
04/06/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Vivian LargusaTIME COMPLETED:
02:35 PM
ALLEGATION(S):
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9
Program site is not kept clean and sanitary at all times for the safety and well-being of clients, employees and visitors.
INVESTIGATION FINDINGS:
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2
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5
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***THIS IS AN AMENDED REPORT FROM VISIT ON 4/6/22***

On 04/29/22 at 2:15 p.m. Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver amended findings from the original compliant investigation findings delivered on 4/06/22. LPA met with Vivian Largusa and explained the purpose of the visit.

During the course of the investigation on performed 4/06/22, LPA toured the facility and interviewed 3 staff. During the facility tour LPA observed that the facility was clean and in good repair. The kitchen was clean and well maintained. LPA did not observe any mold in or on the kitchen sinks. During the tour of the bathrooms LPA observed the bathrooms to be clean and well maintained. The sinks were observed to be clean and no mold was observed.

During the staff interviews all three staff reported that the facility is cleaned by a janitorial crew made up of residents from the agency’s Independent Living Program accompanied by a job coach twice daily: once after lunch and then again at the end of the day. Staff also reported that a professional cleaning crew from an outside vendor cleans the facility on a bi-weekly basis.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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