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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200199
Report Date: 10/18/2024
Date Signed: 10/18/2024 03:00:19 PM

Document Has Been Signed on 10/18/2024 03:00 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:FCSN EAST BAY ADULT DAY PROGRAMFACILITY NUMBER:
019200199
ADMINISTRATOR/
DIRECTOR:		AI-CHING "SYLVIA" YEHFACILITY TYPE:
775
ADDRESS:2300 PERALTA BLVD.TELEPHONE:
(510) 739-6900
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 105CENSUS: 19DATE:
10/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:12 PM
MET WITH:Vivian Largusa, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 10/18/2024, while at the facility for a 1-year Annual Inspection, Licensing Program Analysts (LPAs) P. Manalo and J. Clancy-Czuleger conducted a case management visit regarding an incident report that was reported to CCLD on 09/19/2024.

The incident occurred on 09/19/2024 when client (C1) had an altercation with staff in the morning. Director was informed of the situation from the other staff and approached C1. C1 proceeded to yell at the Director and had another altercation with the Director.

Moving forward, Program Director has been supporting C1 with coping skills and how to manage C1's emotions.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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