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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200207
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:56:38 PM

Document Has Been Signed on 07/18/2024 03:56 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:ROBIN COURTFACILITY NUMBER:
019200207
ADMINISTRATOR/
DIRECTOR:		KRISTABELLE ALATASFACILITY TYPE:
735
ADDRESS:4736 ROBIN COURTTELEPHONE:
(510) 661-0444
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 6CENSUS: 3DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Yolanda Alatas, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 7/3/2024 at 9:05am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Yolanda Alatas, Administrator, and explained the purpose of the visit. LPA toured the facility with Administrator. The facility’s fire clearance was approved for six (6) non-ambulatory clients. There were no clients present during visit.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of eight (8) bedrooms and three (3) bathrooms. Three (3) bedrooms are occupied by staff and one (1) room is used as an office. All indoor passageways are kept free of obstruction. Facility has a swimming pool in a locked gated area. A comfortable temperature for clients is maintained at 78 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 113.3 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. Hand washing poster, paper towel, and soap observed at all hand washing stations. The supply of extra hygiene was available for residents. There is a minimum of 7-day non-perishables and 2-day perishables foods.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ROBIN COURT
FACILITY NUMBER: 019200207
VISIT DATE: 07/18/2024
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Continued from LIC809.

Smoke detectors/carbon monoxide were in operating condition during visit. Emergency disaster plan last updated 8/1/2023. Fire extinguisher last serviced on 2/21/2024. Fire drill last conducted 4/10/2024. First aid kit was observed to be complete.

Four (4) staff records were reviewed, and all staff have first aid and CPR. Three (3) clients' records reviewed. LPA also reviewed P & I.

The following forms to be updated and submitted to CCLD by 7/25/2024:
  • LIC 400 Affidavit Regarding Client/Resident Cash Resources
  • LIC 402 Surety Bond
  • LIC 610D Emergency disaster plan (last page)
  • LIC 500 (Personnel Record)
  • LIC 308 (Designation of facility responsibility)

No deficiencies cited during inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
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