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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200199
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:30:24 PM

Document Has Been Signed on 10/06/2022 03:30 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: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: 30DATE:
10/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Sylvia Yeh, Executive Business Director TIME COMPLETED:
03:35 PM
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On todays date, 10/6/2022, at 2:25 PM, Licensing Program Analyst (LPAs) L. Fici and C. Lin arrived unannounced to conduct Infection Control Inspection. LPAs met with Sylvia Yeh, Executive Business Director and explained the purpose of the visit.

During the inspection, LPAs toured facility including but not limited to common areas, hand washing stations, bathrooms, kitchen and backyard. LPAs observed COVID-19 signage throughout the facility. Hand washing signs were posted at hand washing stations. LPAs observed PPE's are plentiful. Food and paper supplies are sufficient. Hand sanitizer is provided at facility entrance. Water temperature was measured at 116.5 degrees F in common area bathroom. Fire extinguisher was last serviced on 1/11/2022. LPAs observed facility passages inside and out are free of obstruction. First aid kit was observed to be complete. Smoke and carbon monoxide detectors were observed and maintained. Common areas are disinfected twice a day.

During record review, LPAs observed facility has a copy of Infection Control Plan and emergency disaster plan on file.

No deficiencies cited during todays visit.

Exit interview conducted with Sylvia, Executive Business Director and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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