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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200228
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:38:13 PM

Document Has Been Signed on 11/21/2024 03:38 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: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: 18DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Allen Henry, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 11/21/2024 at 2:00 PM, Licensing Program Analysts (LPAs) D. Doidge and C. Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with, Allen Henry, Administrator and explained the purpose of the visit.

LPAs toured the facility including but not limit to,bathrooms, side yard and common area. Facility temperature was maintained at 72 degrees Fahrenheit. The hot water temperature in a common bathroom was measured at 115.7 degrees Fahrenheit.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/24/2024. Emergency disaster drill was last conducted on 10/17/2024. First aid kit was observed to be complete.

LPAs reviewed five (5) resident records and five (5) staff records, all were complete.

No deficiencies observed or cited during this visit. .

Exit interview conducted and a copy of this report provided
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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