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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200228
Report Date: 04/03/2024
Date Signed: 04/05/2024 09:16:00 AM

Document Has Been Signed on 04/05/2024 09:16 AM - 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:HENRY AND HENRY ADULT DAY CAREFACILITY NUMBER:
019200228
ADMINISTRATOR/
DIRECTOR:		ALLEN HENRYFACILITY TYPE:
775
ADDRESS:3361 MACARTHUR BLVD.TELEPHONE:
(510) 530-9656
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY: 30CENSUS: 28DATE:
04/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Allen Henry, AdminTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 4/3/24 at 12:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a collateral visit. LPA met with Administrator(ADM), Allen Henry and explained the purpose of the visit.

LPA interviewed R1 in regards to compliant #15-AS-20240109153159.

LPA forgot to have ADM sign this report.


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