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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200228
Report Date: 10/17/2024
Date Signed: 10/17/2024 01:12:03 PM

Document Has Been Signed on 10/17/2024 01:12 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: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: 25DATE:
10/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Allen Henry, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 10/17/24 at 12:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver amended report for the complaint investigation dated 9/26/24. LPA met with Allen Henry, Licensee and explained the purpose of the visit.

Amended report delivered to licensee.

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: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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